MANUAL  AND  ATLAS 
OF  DISSECTION 


- 

314  ILLUSTRATIONS 


MEDICAL    >SCH<S>©L 


Gift  of 


Panama- Pacific 
Intern '1  Exposition  Go 


A   MANUAL   AND   ATLAS 


OF 


DISSECTION 


BY 

SIMON   MENNO   YUTZY,  M.D. 

INSTRUCTOR    IN   OSTEOLOGY   AND    DEMONSTRATOR    OF   ANATOMY    IN    THK    VNIYERSJTY  OP    MICHIGAN 


tUitb  314  Illustrations 


WITH  AN   INTRODUCTION 

BY 

J.    PLAYFAIR    MCMURRICH,    A.M.,    PH.D. 


PHILADELPHIA 

P.    BLAKISTON'S    SON    &    CO. 

IOI2     WALNUT    STREET 


COPYRIGHT,  1906,  BY  P.  BLAKISTON'S  SON  &  Co. 


PRESS     OF 

WM.    F.    FELL    COMPANY 
•  220-24    SANSOM    STREE 


cm  35 


PREFACE 


The  objects  of  this  outline  are  to  direct  the  student  in  his  work  in 
dissection,  and  to  give  a  method  of  isolating  the  various  structures  with 
system  and  order.  The  work  is  divided  into  demonstrations.  This  means 
that  a  certain  region,  or  regions  called  a  demonstration,  is  to  be  dissected 
out  and  carefully  studied  by  the  student,  and  then  the  dissection  inspected 
by  a  quiz  master,  the  student  quizzed  and  made  to  demonstrate  the  struc- 
tures before  going  on  to  the  dissection  of  another  region. 

The  figures  in  this  outline  are  principally  taken  from  Moms'  and  Hoi- 
den's  "Anatomy,"  and  will  serve  to  give  valuable  suggestions. 


< 


INTRODUCTION 


For  students  attempting  to  use  in  connection  with  their  laboratory  work 
any  of  the  popular  text-books  of  Descriptive  Anatomy,  some  sort  of  guide 
is  necessary.  There  is,  always  a  danger  that  such  a  guide  may  become  to 
the  student  the  sole  source  of  his  information,  which  may  thereby  become 
superficial  and  imperfect.  This  difficulty  may  be  avoided  in  two  ways: 
either  by  making  the  guide  so  comprehensive  that  it  becomes  a  text-book 
of  Topographic  Anatomy,  or  by  reducing  it  to  the  status  of  a  topograph- 
ical index. 

In  the  present  volume  the  latter  plan  has  been  adopted.  The  student 
obtains  from  it  only  a  list  of  the  structures  wrhich  he  should  find  and  study 
during  his  dissection  of  any  part  of  the  body,  together  with  some  concise 
directions  as  to  how  he  should  proceed  with  his  dissection ;  for  a  description 
of  the  structures  he  must  necessarily  turn  to  his  text-book.  The  dangers 
of  the  quiz-compend  are  thus  avoided;  indeed,  the  guide  may  serve  as  an 
excellent  quiz-master  in  supplying  the  student  with  topics  concerning 
whose  relations  he  may  test  his  knowledge.  The  numerous  illustrations 
will  but  serve  to  increase  the  efficiency  of  the  volume  in  both  these  respects. 

The  long  experience  of  my  colleague,  Dr.  Yutzy,  as  a  successful  teacher 
of  Anatomy  is  a  guarantee  for  the  carefulness  and  thoroughness  with  which 
the  book  has  been  planned,  and  the  satisfactory  results  which  have  fol- 
lowed the  use  of  similar  guides  in  the  Anatomical  Laboratory  of  the  Uni- 
versity of  Michigan  awaken  the  hope  that  it  may  prove  equally  satisfactory 
in  a  larger  field. 

J.  PLAYFAIR  McMuRRicn. 


P.  Blaiuton's  Soa  Co, 


CONTENTS 


PART  I— HEAD,  iNECK,  THORAX,  THORACIC  VISCERA, 
AND  UPPER  EXTREMITIES 

PAGE 

Demonstration  I i 

Surface  Anatomy  of  Cranial  Region. 

Demonstration  II 3 

The  Head. 
Auricular  Region. 

Demonstration  III 6 

Face. 

External  Palpebral  Region. 

Nasal  Region. 

Superior,  Inferior,  and  Inter-maxillary  Region. 

Demonstration  IV      12 

Skull. 

Internal  Orbital  Region. 

The  Eye. 

Demonstration  V 20 

The  Neck. 

Triangles  of  the  Neck. 

Demonstration  VI 24 

Anterior  Triangles  of  the  Neck. 
Thyroid  Gland. 
Submaxillary  Triangle. 

Demonstration  VII 33 

Temporo-  and  Pterygo-maxillary  Region. 

Demonstration  VIII      40 

Deep  Dissection  of  the  Neck. 

Demonstration  IX  ....  42 

Anterior  Vertebral  Region. 

Pharynx. 

Palate. 

Tonsils. 

Mouth. 

Teeth. 

Tongue. 

Larynx. 

ix 


x  CONTENTS 

PAGE 

Demonstration  X 56 

Supra-maxillary  Region. 

Nose. 

Ear. 
Demonstration  XI 60 

Back. 

Suboccipital  Triangle. 
Demonstration  XII , 68 

Pectoral  and  Axillary  Region. 
Demonstration  XIII 75 

Thorax  and  Thoracic  Viscera. 

Heart. 

Lungs. 
Demonstration  XIV .       85 

Shoulder  and  Arm. 

Brachial  Plexus. 

Demonstration  XV 95 

Forearm,  Wrist,  and  Hand. 

Anastomoses  of  Arteries  of  Upper  Extremities. 

Demonstration  XVI 113 

Articulations  and  Ligaments. 

Cutaneous  Nerves. 

Sections  of  the  Body  and  Extremities. 


PART  II— ABDOMEN,  ABDOMINAL  VISCERA,  PELVIS,   PELVIC 
VISCERA,  AND  LOWER  EXTREMITIES 

Demonstration  I 133 

Surface  Anatomy  of  Abdomen. 
Demonstration  II 135 

Abdominal  Walls. 

Demonstration  III 141 

Abdominal  Cavity. 
Contents  of  Abdomen. 
Peritoneum. 
Mesenteric  Arteries. 

Demonstration  IV 151 

Removal  of  Abdominal  Viscera. 

Small  Intestines. 

Large  Intestines. 

Stomach. 

Duodenum  and  Pancreas. 

Spleen. 


COX  TEXTS  xi 

PACE 

Demonstration  V J59 

Liver. 

Kidney  and  Suprarenal  Body. 
Demonstration  VI ...     164 

Structures  on  Posterior  Wall  of  Abdomen. 

Solar  Plexus. 

Lumbar  Plexus. 
Demonstration  VII     ...  ....     171 

Pelvic  Region. 

Demonstration  VIII      .  J?3 

Perineum. 
Male  Perineum. 
Pelvic  Fascia. 
Female  Perineum. 

Demonstration  IX 186 

Pelvic  Viscera. 

Rectum. 

Male  Reproductive  Organs. 

Female  Reproductive  Organs. 

Demonstration  X ...     194 

Cavity  of  Pelvis. 
Sacral  Plexus. 
Sympathetic  Nerves. 

Demonstration  XI  ...  199 

Gluteal  Region. 
Demonstration  XII -     205 

Anterior  Femoral  Region. 

Internal  Femoral  Region. 
Demonstration  XIII -     215 

Popliteal  Space. 

Posterior  Femoral  Region. 

Demonstration  XIV 219 

Anterior  Tibio-Fibular  Region. 

Demonstration  XV 225 

Posterior  Tibio-Fibular  Region. 

Plantar  Region. 

Anastomoses  of  Arteries  of  Lower  Extremities. 

Demonstration  XVI 239 

Articulations  and  Ligaments. 
Sections  of  the  Body  and  Extremities. 


PART 


HEAD,   NECK,   THORAX,   THORACIC  VISCERA,  AND   UPPER 

EXTREMITIES 


GENERAL  REMARKS  TO  THE  STUDENT 


It  will  add  much  to  the  comfort  of  all  in  the  dissecting-room  if  each 
student  sees  that  his  material,  table;  and  floor  about  the  table  are  kept 
clean. 

Do  no  cutting  before  you  have  familiarized  yourself  with  the  region 
upon  which  you  are  working.  Read  the  descriptive  anatomy  in  your  text- 
books and  examine  the  figures  of  the  parts  about  to  be  dissected.  Identify 
the  landmarks  and  the  relations  they  bear  in  position  to  the  deeper  struc- 
tures. 

Then  carefully  work  out  each  structure,  studying  each  part  fully  as 
it  is  exposed,  noting  its  appearance  and  position  in  relation  to  other  parts. 

Clean  muscles,  noting  their  form,  origin,  insertion,  action,  and  innerva- 
tion.  Remove  the  tissue  from  blood-vessels  and  nerves,  and  trace  their 
branches  as  far  as  possible. 

When  a  region  is  fully  dissected  out  review  frequently  and  carefully 
the  dissection  on  the  cadaver,  observing  each  part  in  its  proper  position 
and  its  relation  to  surrounding  parts.  Learn  to  observe  intelligently  what 
you  see.  Observation,  examination,  and  analysis  are  important  qualities 
to  the  successful  study  and  practice  of  medicine,  and  the  earlier  the  habit 
of  accuracy  in  these  qualities  is  formed,  the  greater  the  success. 

Each  student  should  make  a  drawing  of  his  dissection. 


xvi 


MANUAL  AND  ATLAS  OF  DISSECTION. 


DEMONSTRATION  I. 


CRANIAL  REGION 


Shave  the  head. 

Surface  anatomy : — • 

Identify    the    following   bony    landmarks: — Xasion,     glabella,    inion, 


bregma,  lambda,  frontal  eminence,  parietal  eminence,  zygomatic  arch,  tem- 
poral ridge,  supra-orbital  arch,  supra-orbital  notch  or  foramen. 


GENERAL  REMARKS  TO  THE  STUDENT 


It  will  add  much  to  the  comfort  of  all  in  the  dissecting-room  if  each 
student  sees  that  his  material,  table/  and  floor  about  the  table  are  kept 
clean. 

up< 
bo( 
the  ERRATA. 

tui 

Page  48,  under  muscles  of  tongue,  read  "  Extrinsic.     (See  Fig.  55)" 

instead  of  Fig.  60. 
it  l 

Page  48,  under  muscles  of  tongue,  read  "Intrinsic.      (See  Fig.  55)" 
,  •  instead  of  Fig.  60. 

br£  PaSe  69>  twelfth  line  from  bottom,  read  "  Figs.  95,  99,  100  "  instead 

of  Figs.  94,  98,  100. 

the 
an< 

yoi  , 

to  the  successful  study  and  practice  of  medicine,  and  the  earlier  the  habit 
of  accuracy  in  these  qualities  is  formed,  the  greater  the  success. 
Each  student  should  make  a  drawing  of  his  dissection. 


xvi 


MANUAL  AND  ATLAS  OF  DISSECTION. 


DEMONSTRATION  I. 


CRANIAL  REGION 


Shave  the  head. 

Surface  anatomy : — 

Identify    the    following   bony    landmarks: — Xasion,     glabella,    inion, 


FIG.   i. — THE  SKULL. — (Morris.) 

BREGMA 


GLABELLA  NASIO 


bregma,  lambda,  frontal  eminence,  parietal  eminence,  zygomatic  arch,  tem- 
poral ridge,  supra-orbital  arch,  supra-orbital  notch  or  foramen. 


2  THE  HEAD 

With  coloured  pencil  or  crayon  outline  the  arteries  of  the  head  and  face. 
Also  outline  veins  of  head  and  neck.     (See  Fig.  5.) 

FIG.  2. — BRANCHES  OF  THE  EXTERNAL  CAROTID  ARTERY. — (Holden,} 

r.  External  carotid.  2.  Lingual.  3.  Facial.  4.  Inferior  labial.  5.  Inferior  coronary. 
6.  Superior  coronary.  7.  Lateral  nasal.  8.  Angular.  9.  Superior  thyroid.  10  and 
16.  Occipital,  ir.  Posterior  auricular.  12.  Anterior  auricular.  13.  Internal  maxil- 
lary. 14.  Transverse  facial.  15.  Middle  temporal.  17.  Anterior  temporal.  18. 
Posterior  temporal.  19.  Supra -orbital.  20.  Frontal. 


Also  outline  superficial  nerves  of  head  and  neck.     (See  Figs.  3  and  4.) 
Describe  muscle,  tendon,  aponeurosis,  superficial  and  deep  fasciae. 


THE  HEAD 


DEMONSTRATION  II. 

Dissection. — Make  a  vertical  incision  through  the  skin  only,  from  the 
root  of  the  nose  to  the  external  occipital  protuberance.  Make  a  second  inci- 
sion horizontally  along  the  forehead  and  around  the  side  of  the  head,  from 
the  anterior  to  the  posterior  extremity  of  the  first  incision. 

Remove  the  skin  with  great  care  so  as  not  to  remove  the  blood-vessels 
and  nerves  lying  in  the  superficial  fascia. 
Study  the  skin  of  the  scalp. 
Study  the  fascia  of  the  scalp. 

Dissect  out  and  study  the  following  nerves  and  blood-vessels: — 
Nerves  (see  Figs.  3  and  4):— 
Frontal. 

Supra -orbital.  FlG- 

Supratroch- 

lear. 
Auriculo-t  e  m  - 

poral. 
Orbital  or  tem- 

poro-malar. 
Temporal 
branch    of 
seventh. 
Occipitalis  ma- 
jor. 

Occipitalis  mi- 
nor. 


THE  HEAD 

FIG.  4. — CRANIAL  NERVES. — (Potter.) 


. 

2.  Infra.-  tree/dear, 

3.  •Supm-ort>ttai,3t>i' 

4.  Auricula-temporal.  SO* 


6  Tempor 
7,  Mater; 


Arteries  (see  Fig.  2) : — 
Supra-orbital. 
Frontal. 

Superficial  temporal. 
Posterior  auricular. 
Occipital. 

Veins  (see  Fig.  5 ) : — 
Supra-orbital. 
Frontal. 
Temporal. 
Posterior  auricular. 
Occipital. 

Study  lymphatics  of  head  and  face.  Some  of  the  larger  lymphatic 
nodes  can  be  dissected  out.  The  smaller  nodes  and  lymphatic  vessels 
cannot  be  seen  in  dissection,  and  the  student  must  be  satisfied  with 
studying  the  text  and  figures  in  books. 

Expose  and  study  occipito-frontalis  muscle  (M.  epicranius}.  (See 
Fig-  7-) 


THE  HEAD. 


FIG.   5. — -TiiE   SUPERFICIAL  LYMPHATICS  AND  VEINS  OF  THE  SCALP,  FACE,  AND  NECK. — 

(Morris.) 


Frontal  vein 


Si/praorbital  rein 
Communication  with. 

ophthalmic  rein 
Tranxverte  nasal  rein 


Angular  vein 
Lateral  nasal  veins 

Transverse  facial 

rein 
Superior  labial  or 

coronary  rein 

A  n  terior  pterygoid 

or  deep  facial  rein 

Inferior  coronary 

rein 

facial  rein 

Inferior  labial  veil 

Submental  rein 
Lingual  rein 

Superior  thyroid 
vein 

Middle  thyroid 

rein 

Btemo-mastoid 

Anterior  jugular 

rein 

Communication 
between  anterior 
jugular  reins 
Platysma,  cut 


Anterior  temporal  vein 
Posterior  temporal  rein 

Deep  temporal  rein 
Parotid  lymphatic  gland* 
Common  temporal  rein 
Internal  maxillary  vein 
Occipital  vein 
Temporo-maxillary  vein 
P?^—     Posterior  auricular  vein 

Occipital  lymphatic  glandt 
Slerno-mastoid  lymphatic 

glands 

Communication  between 
facial    and    external 
jugular  reins 
Sitbmaxillary  lymphatic 

glandt 
Internal  jugular  rein 

Posterior  external  jugular 

vein 
External  jugular  vein 


Superficial  cervical  chain 
of  glands 


Trapezius 


Transverse 
cervical  vein 

S  Stiprascapular 
vein 


Jugulo-cephalic 
vein 


AURICULAR  REGION 

Carefully  remove  the  skin  from  about  the  auricle  and  expose  the  ex- 
trinsic muscles  of  the  auricle:— 

Attrahens  aurem  (M.  auricularis  anterior}.     (See  Fig.   7.) 
Attollens  aurem  (M.  auricularis  superior}. 
Retrahens.  aurem  (M.  auricularis  posterior}. 

Draw  the  auricle  in  a  direction  from  the  point  of  origin  of  the  muscle; 
this  will  make  the  muscle-fibres  prominent  and  the  muscle  can  be  ex-posed. 
Expose  the  following  nerves  and  blood-vessels: — 
Nerves  (see  Fig.  3) : — 
Posterior  auricular. 

Auricular  branch  of  auricularis  magnus. 
Arteries  (see  Fig.  2) : — 
Posterior  auricular. 


THE  FACE 


DEMONSTRATION  III. 
FACE 

EXTERNAL  PALPEBRAL  AND  ORBITAL  REGIONS 

General  surface  view. 

Appendages  of  the  eye. 
Eyebrows. 
Eyelids. 

Outer  and  inner  canthus. 
Eyelashes. 
Tarsal  plates. 

Study  and  trace  the  conjunctiva. 
Observe  caruncula  lachrymalis. 

FIG.  6. — -LACHRYMAL  APPARATUS. — (Morris.) 


SUPERIOR  LACHRYMAL  GLAND 
INFERIOR  LACHRYMAL  GLAND 


DUCT  FROM  SUPERIOR  GLAND 


UPPER  EYELID  PARTIALLY 
DIVESTED  OF  SKIN 


UPPER  PUNCTUM 

LACHRYMAL  SAC,  NEAR  ITS  FUNDUS 

COMMON  DUCT  FORMED  BY  JUNC- 
TION OF  CANALICULI 

UPPER  AND  LOWER  CANALICULI 
LOWER  PUNCTUM 


NASAL  DUCT 


Lachrymal  apparatus: — 

Lachrymal  gland. 

Puncta  lachrymalia. 

Lachrymal  canal. 

Lachrymal  sac. 

Nasal  duct. 

Pass  a  probe  into  the  puncta  lachrymalia  and  out  the  lachrymal  canal 
into  the  lachrymal  sac.  Slit  open  the  inferior  lachrymal  canal  to  the  sac 
and  then  pass  a  probe  down  the  nasal  duct. 

Make  an  incision  through  the  skin  encircling  the  anterior  border  of 
the  orbit ;   remove'  the  skin  over  the  eyelids  to  their  edges  and  expose : — 
Muscles : — - 

Orbicularis  palpebrarum  (M.  orbicularis  ocidi),     (Fig.  7.) 

Tensor  tarsi. 

Tendo  oculi. 

Corrugator  supercilii.     (Fig.  7.) 

Levator  palpebrae  superioris. 
Nerves  (see  Figs.  3  and  4) : — 

Supra-orbital. 

Supratrochlear. 

Infratrochlear. 


THE  FACE  7 

Arteries  (see  Fig.  2) : — 
Supra -orbital. 
Frontal. 
Nasal. 
Palpebral. 
Lachrymal. 

Observe  the  Meibomian  glands  in  the  tarsal  plates  by  holding  the 
eyelids  between  you  and  the  light.     (Fig..  8.) 

FIG.  7. — (Holden.) 


LEVATOR  Bit 


Expose  the  tendons  of  the  muscles  inserted  into  the  sclerotic  coat  of 
the  eye  by  cutting  through  conjunctiva  between  the  eyelids  and  eyeball. 
To  keep  the  insertion  of  the  tendons  in  view  place  a  splinter  under  each. 

Moderately  distend  the  cheek  with  tow  and  stitch  the  lips  togetlier.  Make 
a  longitudinal  incision  through  the  skin  down  the  median  line  of  the  face  to 
the  upper  lip,  then  carry  an  incision  along  the  margin  of  the  lip  and  trans- 
versely across  the  face  to  the  angle  of  the  jaw.  Turn  the  skin  outwards. 


THE  FACE 

FIG.  8. — TENSOR  TARSI  ATTACHMENT  OF  THE  ORBICULARIS  PALPEBRARUM  TO  THE 

PART  OF  THE  BASE  OF  THE  ORBIT. — (Holden.) 

i.  Inner  wall  of  the  orbit.  2,  2.  Internal  part  of  the  orbicularis  palpebrarum.  3,  3. 
Attachment  of  this  muscle  to  the  circumference  of  the  base  of  the  orbit.  4.  Open- 
ing for  the  nasal  artery.  5.  Tensor  tarsi.  6,  6.  Posterior  view  of  the  lids.  7,  7. 
Orbital  portion  of  the  lachrymal  gland.  8,  9,  10.  Palpebral  portion  of  this  gland, 
n,  n.  Mouths  of  its  excretory  ducts. 


NASAL  REGION 

Expose  the  following  structures: — 
Arteries   (see  Fig.   2) : — 

Lateralis  nasi. 

Angular. 

Muscles  (see  Fig.  7) : — 
Pyramidalis  nasi. 

Levator  labii  superioris  alaeque  nasi. 
Dilator  naris  posterior. 
Dilator  naris  anterior. 
Compressor  nasi. 
Compressor  narium  minor. 
,  Depressor  alae  nasi. 

Nerves : — 

Nasal  branch  of  ophthalmic. 
Nasal  branch  of  infra-orbital. 


SUPERIOR,  INFERIOR,  AND  INTER-MAXILLARY  REGION 

Make  an  incision  along  the  margin  of  the  lower  lip  and  turn  the  skin 
down  to  the  lower  border  of  the  mandible. 

Study  the  parotid  fascia.  Carefully  expose  the  surface  of  the  parotid 
gland.  Exercise  great  care  in  this  region  so  as  not  to  cut  any  branches 
of  the  facial  nerve. 

Study  the  parotid  gland.     (Fig.  9.) 


THE  FACE  9 

Expose  the  facial  nerve  by  first  finding  the  infra-orbital  branch.  This 
lies  below  the  zygomatic  arch  and  close  to  the  parotid  duct.  Trace  the 
nerve  forwards  under  the  levator  labii  superioris  muscle,  and  expose  the 
infra-orbital  plexus.  At  the  same  time  trace  forwards  the  parotid  duct  to 
where  it  pierces  the  buccinator  muscles.  Now  trace  the  infra -orbital 
branch  back  into  the  parotid  gland,  carefully  looking  for  the  other  branches 
of  facial  nerve.  (See  Fig.  3.) 


FIG.  9. — (H olden.) 


Branches  of  the  facial  nerve  on  the  face  (Fig.  3) 
Temporo-facial. 
Temporal. 
Malar. 

Infra -orbital. 
Cervico-facial. 
Buccal. 

Supra -maxillary. 
Infra -maxillary. 

Auricularis  magnus  nerve  of  cervical  plexus. 
Muscles  (see  Fig.   7): — • 

Platysma  myoides. 

Superior  maxillary  region. 
Levator  labii  superioris. 


io  THE  FACE 

Levator  anguli  oris. 

Zygomaticus  major. 

Zygomaticus  minor. 
Intermaxillary  region. 

Orbicularis  oris. 

Buccinator. 

Risorius. 
Inferior  maxillary  region. 

Levator  labii  inferioris. 

Depressor  labii  inferioris. 

Depressor  anguli  oris. 

FIG.  io. — -THE  CRANIAL  NERVES.     FIFTH  NERVE — TRIGEMINUS. — (Potter.) 


.Potter  del 


Branches  of  fifth  nerve  on  face  (see  Fig.  4)  :— 
Infra -orbital. 

Palpebral. 

Nasal. 

Labial. 

Malar. 

Auriculo-temporal. 

Mental. 
Study  the  whole  of  fifth  or  trifacial  nerve  at  this  time.     (Fig.  io.) 


THE  FACE.  IT 

Study  the  whole  of  facial  nerve  at  this  time. 
FIG.   ii.— THE  CRANIAL  NERVES.     SEVENTH  NERVE — FACIAL  OR  PORTIO  DURA. — (Potter.} 


~lfcntal5a* 


References 
I.  LargeSuperf.  Petrosal.toform  Vidian  with  N*?5 

2  Small  Superf.  Petrosal,to    utic  Ganglion. 

3  External  Superf.  Petrosal,  to  Plexus  on  MidMenmgeal  Artery. 

4  Tympanic  Br.  to  Stapedius.etc 

5  Br  From  Carotid  Plexus.Making  Vidian, with  N*?l. 
6.  7.  Brs.to  Auriculo  -Temporal  of  5^ 

8.  Br  to  Auricular  of  Vagus  Potter.deL 

M.The  Ganglion  of  Meckel 

O.A.F.  Orifice  of  Aqua3doctus  Fallopii 

Arteries  on  the  face  (see  Fig.   2) : — 

Facial  and  branches  (.-1.  maxillaris  externa). 

Transverse  facial. 

Middle  temporal. 

Orbital  (A.  zygomatico-orbitalis). 

Infra-orbital. 

Mental. 
Veins  on  face  (see  Fig.   5) : — 

Frontal. 

Supra-orbital. 

Angular. 

Facial  and  branches. 

Temporal. 

Internal  maxillary. 

Temporo-maxilla  ry . 

Posterior  auricular. 
Lymphatics  (see  Fig.  5) : — 

Study  lymphatics  of  head,  face,  and  neck 


12  THE  SKULL 

DEMONSTRATION  IV. 
SKULL 

Study  the  external  surfaces  of  the  superior,  posterior,  lateral,  and 
anterior  regions  of  the  skull. 

Remove  the  skull-cap  by  making  a  circular  incision  with  the  saw,  com- 
mencing in  front  about  one  inch  above  the  margin  of  the  orbit,  and  extending 
behind  a  little  above  the  external  occipital  protuberance.  Saw  through  the 
bone  only,  and  with  chisel  and  hammer  break  the  skull-cap  loose  with  care 
so  as  not  to  break  the  investing  membranes  of  the  brain. 

Observe  the  interior  of  skull-cap.  Note  groove  for  middle  meningeal 
artery. 

Examine  diploe  by  chiseling  away  part  of  the  outer  plate  of  skull-cap. 

Study  veins  of  diploe. 


FIG.   12.— THE  VEINS  OF  THE  DIPLOE. — (Morris.) 
(From  a  specimen  in  St.  Bartholomew's  Hospital  Museum.) 


THE  LAMBDOID 
SUTURE 

The  occipital  or 
parieto-occipilal 
diploic  vein 

The  external  pari- 
etal or  posterior 
temporal  diploic 
vein 

THE  MASTOID 
FORAMEN 


THE  CORONAL  SUTURE 


The     frontal     di- 
ploic vein 

The     fronto-sphe- 
noidal  diploic 
vein 

The  Jronto-pari- 
e/al  or  anterior 
temporal  diploic 
vein 


Observe  middle  meningeal  artery.     What  is  its  origin  and  course? 

Membranes  of  brain:— 

Study  dura  mater. 

Make  a  puncture  in  median  line  of  dura  mater,  insert  a  blow-pipe,  and 
distend  with  air  the  superior  longitudinal  sinus.  Then  make  an  incision 
through  the  dura  on  one  side  of  the  superior  longitudinal  sinus  and 
turn  the  dura  outwards.  Observe  the  falx  cerebri  and  tentorium  cere- 
belli.  (Fig.  13.) 

Study  superior  longitudinal,  inferior  longitudinal,  and  straight  sinuses. 

Study  arachnoid  and  pia  mater. 

Observe  the  glandulae  Pacchioni. 


ARTERIES  AT  THE  BASE  OF  BRA IX 


FIG.   13. — THE  VENOUS  SINUSES.     (Longitudinal  section.) — (Morris.) 


FUlRItt  SERVE 

I 


Fall  cerebri 


THIRD  SERVE 

SECOXD  NERVE 


Lateral  tinui 


Superior 
petrotal  sinus 

Fali-cere  belli 

8MVXSTMAND 

EIGHTH 

irssrss 

.v/.vTV/.  TESTH.  Ayr) 

ELEVENTH  SERVES 
TWELFTH  SERVE 

SECOSD  CERVICAL  NERVE 

Ligamentum  denticulatum 


Vertebral 
artery 


FIFTH 
NER  VE 


fJKST 

CERVICAL 

SER  VE    Inferior  pttrosa!  sinta 


Remove  the  brain.  Lift  the  frontal  lobes  from  the  dura  and  turn  the 
brain  back.  Observe  tlie  cranial  nerves.  Cut  the  nerves  so  that  part  is  left 
on  the  base  of  cranium.  Cut  through  the  tentorium  cerebelli  along  its  attach- 
ment to  the  superior  border  of  the  petrous  portion  of  temporal  bone.  Push 
the  cerebellum  to  one  side  and  observe  the  nerves  as  they  leave  the  brain,  cut 
the  nerces,  and  then  thrust  a  knife  into  the  vertebral  canal  and  divide  the 
spi)ial  cord. 

Study  the  arteries  at  the  base  of  the  brain  (Fig.  14): — 
Cerebral  portion  of  internal  carotid. 
Anterior  cerebral. 
Middle  cerebral. 
Posterior  communicating. 
Anterior  choroid. 
Basilar  and  branches. 

Circle  of  Willis  (Fig.  14)  (Circuliis  arteriosus]  is  formed  by: — 
Anterior  cerebral. 
Anterior  communicating. 
Posterior  cerebral. 
Posterior  communicating. 


FIG.   14. — THE  ARTERIES  OF  THE  BRAIN.— (Morris.) 

(The  posterior  part  of  the  cerebrum  on  the  left  side  has  been  cut  away  to  show  the  cere- 
bellum.    From  a  preparation  in  the  Museum  of  St.   Bartholomew's  Hospital.) 


Anterior  cerebral 
artery 


Middle  cerebral 

artery 
Internal  carotid 

artery 
Postero-jmedian 

perforating 
Posterior  cerebral 

artery 

Superior  cerebellar 
artery 

Anterior  inferior 
cerebellar  artery 


Vertebral  artery  — 


Posterior  inferior 
cerebellar  artery 


Observe  where  the  cranial  nerves  leave  the  brain. 

/     FIG.  15. — VIEW  OF  THE  BASE  OF  THE  BRAIN. — (Morris.) 


OLFACTORY 
BULB 


OPERCULUM 


3rd  or  OCULO- 
MOTOR 


ethor  ABDUCEXT 

7th  or  FACIAL 

8th  or  AUDITORY 

9th,  GLOSSO- 

PHARYNG. 

toth,  PNEUMO- 

GAST. 

llth,  SPINAL 
ACCESS. 
12th,  HYPO- 
GLOSSAL 


Anterior  com- 
municating 
artery 

Antero-lalentl 
perforating 

A  nterior  choroid 

Posterior 
communicating 
artery 

Posterior  choroid 

Bnsilar  artery 
Cms  cerebelli,  cut 


Anterior  spinal 
artery 


XTERIOR 

PERFORA  TED 

SPACK 
PITUITARY 

BODY 
TUBER 


CORPUS 

ALBH'A  V.s' 
POST.  PERF. 

SPACE 
CRUS  CKRERRI 

PI>XS   VAROLII 


AXTERIOR 
PYRAMID 
OLIVARY  ROOT 


IXFKRIOR 

VERMIFORM 
PMOCS8S 


BASE  OF  CRANIUM  15 

Place  the  brain,  if  in  good  condition,  in  alcohol  or  formalin  for 
future  use. 

The  central  nervous  system  is  so  important  and  so  extensive  that  a 
separate  dissection  is  advisable,  therefore  the  directions  for  the  dissection 
of  the  brain  and  spinal  cord  are  not  given  in  this  outline. 

Xow  note  the  exit  of  the  cranial  nerves  through  the  dura  and  base  of 
cranium. 


FIG.   16. — THE  VENOUS  SINUSES. — (Morris.) 
(From  a  dissection  by  W.  J.  Walsham  in  St.  Bartholomew's  Hospital  Museum.) 


Meningral  branch  of 
anterior  etkmoidal  artery 


Meningeal  branch  of  pos- 
terior tthmfjidal  artery 


Middle  meningeal 

artery 

OPHTHALMIA 

I>rvISH>\  OF 

FIFTH  SERVF 

THIRD  SERVE 

Oarernoux  tin  us 

FOURTH  XERVE 

Al'l'ITORY  A\r> 

FACIAL  NERVES 

Sxjtfridr  pftf  • 
Inferior  fxti' 
Petro-tqnamous  fin  us 
tPIXAL 

.'}•  .\ERIF 
Siyi' 

latfrnl  situu 
Posterior  meniniftal 
branch  of  vertebral 
artery 
Left  marginal  riniu 


Lrfl  lateral  tiniu 
Snptrirjr  I'jnqitu-iinal  tiatu 


Circular  tinut 
Carotid  artery 
SIXTH  XER  VE 
Batilar  artery 
Basilar  plexvt  of  reuw 
A  iiditory  artery 
Vertebral  ai'tetf 

"HAKrSGEAL 
A\I>  PXEl'MOGASTKIC 
Anterior  spinal  artery  [.V. 

HYPOGLOSSAL 

SERVE 

SPIXAL  ACCES- 
.-<'>/:  Y  SFR  VE 

Right  marginal  tinnt 
Occipital  tinut 
Right  lateral  tinut 


Expose  the  sinuses  of  the  dura  mater  (see  Figs.  13  and  16): — 
The  superior  longitudinal,  inferior  longitudinal,  and  straight  sinuses 
have  been  seen. 


The  remaining  are:- 
Lateral. 
Occipital. 
Cavernous. 


Circular. 

Superior  petrosal. 
Inferior  petrosal. 
Transverse. 


Study: — Ophthalmic  veins  and  emissary  veins. 

Name  and  locate  the  openings  through  the  base  of  cranium  in 


It) 


THE  ORBIT 


Anterior  cranial  fossa. 
Middle  cranial  fossa. 
Posterior  cranial  fossa. 


INTERNAL  ORBITAL  REGION 

Remove  the  roof  of  the  orbit  by  making  one  section  with  the  saw  on  the 
outer  angle  and  one  on  the  inner  angle  of  the  orbit,  so  that  the  two  sections 
converge  at  the  optic  foramen.  Be  careful  not  to  injure  the  pulley  at  the  inner 
angle  for  superior  oblique  muscle.  Do  not  cut  entirely  through  the  bone 
with  the  saw,  but  with  a  hammer  break  the  anterior  part  of  orbit  transversely 
and  turn  this  forwards  and  downwards.  Remove  the  rest  of  the  roof  with 
bone  forceps  back  to  the  optic  foramen.  Now  insert  a  blow-pipe  into  cra- 
nial end  of  optic  nerve  and  distend  the  eyeball  with  air. 

Study  the  periosteum  of  the  orbit.  Notice  it  is  a  continuation  of  the 
dura  mater  through  the  sphenoidal  fissure. 

Study  the  fascia  of  the  orbit. 

Next  expose  the  following  structures: — 

Lachrymal  gland.     (Figs.  6  and  8.) 

FIG.  17. — VIEW  OF  ORBIT  FROM  ABOVE. — (Holden.) 


IN  FRA-TROCHLEAR 


SUPRA-ORBITAL 


SUPRA- 
TROCHLE  AR 


NASAL • 


LAC  HRYM AL 
FRONTAL 


Nerves : — 

Ophthalmic. 

Frontal. 

Lachrymal. 

Nasal. 
Ciliary  ganglion. — (This  lies  between  the  external  rectus  muscle 

and  optic  nerve  in  posterior  third  of  orbit.}     (Fig.  18.) 
Motor  oculi. 
Trochlear. 
Abducens. 

Orbital  branch  of  superior  maxillary. 
Optic. 


THE  ORBIT 
FIG.   iS. — NERVES  OF  THE  ORBIT,  FROM  THE  OUTER  SIDE. — (Morris.) 

I.  FXTICULA  R  GA  NGLION 
SUPERIOR  DIVISION  OF  THE  THIRD  NERVE 


SUPRAORBITAL 

SERVE 


SHORT  f'JLlARY. 
SERVES 


SPA  NCH  OF  THIRD  TO 
INFERIOR  OBLiqUE 


NASAL  BRANCH  OF  OPHTHALMIC 

LONG  ROO  T  OF  LENTICU- 
LAR GANGLION 

OPTIC  NERVE 


THIRD  NERVE 
SIXTH  NERVE 
GASSERIAN  GANGLION 


OPHTHALMIC  DIVISION 
OF  FIFTH  NERVE 


SHORT  ROOT  OF  SYMPA  THETIC  ROOT  OP  LENTICULAR 

LENTICULAR  GANGLION  GANGLION 


Arteries  (see  Fig.   19): — 

Ophthalmic  and  branches. 
Veins : — 

Ophthalmic  and  tributaries. 
Muscles  (see  Fig.  20): — 

Levator  palpebrae. 

Rectus  superior. 

Rectus  inferior. 

Rectus  externus. 


Rectus  internus. 
Superior  oblique. 
Inferior  oblique. 


FIG.   19. — THE  LEFT  OPHTHALMIC  ARTERY  AND  VEIN. — (Morris.) 


Svpraorbital  artery 

LACHRYMAL  GLAND 

Superior  rectus,  cut 

EYEBALL 


External  rectus 
Lachrymal  artery 

Superior  rectus,  cut 
Jnferitjr  ophthalmic  rein 
Superior  ophthalmic  rein 


OPTIC  NERVE 
Common  ophthalmic  vein 


Commencement  of  tuperior 
ophthalmic  rein 

Reflected  tendon  of  superior 

oblique 
Ophthalmic  artery 


Anterior  ethmoidal  artery 

Posterior  ethmoidal  artery 

Ciliary  arteriet 

* 

Levator  palpebrae,  cut 
Ligament  of  Zinn 
Ophthalmic  artery 

OPTIC  COMMISSURE 


Internal  carotid  artery 


i8 


THE  EYE 


FIG.  20   (see   also   Fig.  18). — VIEW  OF   LEFT  ORBIT   FROM  ABOVE,  SHOWING  THE  OCULAR 
«  MUSCLES. — (Morris.) 


Internal  rectus  muscle 


Superior  oblique  muscle 


Trochlea 


Levator  palpebrae  superioris 
muscle,  cut 


External  rectua  muscle 

Inferior  oblique  muscle 
Superior  rectus  muscle 


Levator  palpebrae  superioris 
muscle,  cut 


THE  EYE 

Dissect  the  eye  of  an  ox  or  sheep.  Remove  the  muscles  and  fat  about 
the  eyeball. 

Study  the  aqueous  humor,  sclerotic  coat,  and  cornea.  Then  cut 
through  the  sclerotic  coat  just  behind  the  cornea,  nearly  encircling  the 
eye,  and  turn  forwards  the  anterior  part.  Note  the  iris  and  pupil. 

Float  out  the  crystalline  lens  and  vitreous  in  water.  Study  the  lens 
and  its  capsule  and  vitreous.  Then  note  and  study  choroid,  ciliary  pro- 
cesses, retina,  anterior  and  posterior  chambers. 


FIG.  21. — SURFACE  OF  CHOROID  AND  IRIS  EXPOSED  BY  REMOVAL  OF  SCLEROTIC  AND  COR- 
NEA, SHOWING  DISTRIBUTION  OF  BLOOD-VESSELS  AND  NERVES.  (Twice  natural  size.) 
— (Morris.) 


A  CILIARY  NERVE 


SURFACE  OF  CHOROID  IN 
CILIARY  REGION 


A  CILIARY  XERVE 


Long  posterior  ciliary 
artery 


FLAP  OF  SCLEROTIC, 
REFLECTED 


THE  EYE 


FIG.  22. — SEMI-DIAGRAMMATIC  HORIZONTAL  SECTION  THROUGH  EYEBALL  AND  OPTIC  NERVE. 

— (Morris.') 

Corneal  epithelium 

CORNEA 

; ^/ ^NX 

CANAL  OF  SCHLEUU 
Ciliary  muscle 


CANAL  OF  PETIT 


cowimci  -A 


MOM  : 

BETIXA 


Central  retinal  vessel* 

OPTIC  XERVE- 

Sl'BXTAXCE 

PIAL  XERVE- 


SCLEROTIC 

(covered  exter- 
nally by  Tenon't 
capsule  and 

loose  tissue) 


DURAL  XERVE-SHEATH 


20 


THE  NECK 


DEMONSTRATION  V. 
THE  NECK 

Place  the  body  upon  its  back  with  a  block  under  the  upper  part  of  the 
thorax;  turn  the  face  to  one  side.  You  will  see  that  the  side  of  the  neck  pre- 
sents a  quadrilateral  figure,  the  boundaries  of  which  are: — Anterior,  middle 
line;  posterior,  anterior  margin  of  trapezius  muscle;  superior,  mandible; 
inferior,  clavicle  and  manubrium. 

FIG.  23. — ANTERIOR  AND  LATERAL  CERVICAL  MUSCLES. — (Morris.} 


Stylo-glossus 

Hyo-glossus 

Mylo-hyoid 

Anterior  belly 
of  digastric 

Raphe  of  raylo- 
hyoid 

Thyro-hyoid 
Inferior  constrictor 

Anterior  belly  of 
omo-hyoid 

Sterno-hyoid 
Sterno-thyroid 


Stylo-hyoid 

Posterior  belly  of  digastric 

Splenius  capitis 

Sterno-mastoid 

Levator  anguli  scapulae 

Scalenus  medius 
Trapezius 

Scalenus  posticus 


Posterior  belly  of 
omo-hyoid 


Surface  anatomy: — 

Outline  sterno-mastoid  muscle.  This  muscle  divides  the  neck  into  an 
anterior  or  carotid  and  a  posterior  triangle.  The  omo-hyoid  muscle  divides 
the  anterior  triangle  into  a  superior  and  inferior  carotid  triangle;  and 
the  posterior  triangle  into  the  subclavian  and  occipital.  The  submaxil- 
lary  or  digastric  triangle  is  between  the  mandible  and  stylo-hyoid  and 
digastric  muscles. 

Locate  the  hyoid  bone,  thyroid  and  cricoid  cartilages,  and  trachea. 
As  the  trachea  passes  down  from  the  cricoid  cartilage  it  recedes  so  that 
there  is  a  deep  fossa — fonticulus  gutturis — above  the  sternum. 

Dissection: — Make  a  vertical  incision  through  the  skin  down  the  middle 
of  the  neck  from  the  symphysis  of  the  mandible  to  the  sternum,  a  second  in- 
cision along  the  clavicle  to  the  acromion  process.  Reflect  the  skin  outwards 
to  the  anterior  boundary  of  the  trapezius  muscle. 


THE  NECK 


21 


This  will  expose  the  superficial  fascia  and  platysma  myoides  muscle. 
Study  the  superficial  cervical  fascia. 

FIG.  24. — THE   SUPERFICIAL  VEINS  AND  LYMPHATICS  OF  THE   SCALP,   FACE,   AND    NECK. 

— (Morris.) 


Frontal  i  tin 


SiipraorbUal  vein 
Communication  with 

ophthalmic  vein 
Transrtrse  natal  r 


Angular  rtin 
Lateral  natal  reins 

Transverse  facial 

vein 
Superior  labial  or 

coronary  rein 

Anterior  p'terygoid 

or  deep  facial  rein 

Inferior  coronary 

vein 

Facial  rein  - 

Inferior  labial  vein 

Submental  rein 

Lingual  vein 

Superior  thyroid 

Middle  thyroid 
vein 

Sterno-maatoid 

A  nterior  j«ou  lor 

rein 

Communication 
between  anterior 
jugular  veins 

Platysma 


Anterior  temporal  vein 
Posterior  temporal  vein 

Deep  temporal  vein 
Parotid  lymphatic  gland* 
Common  temporal  rein 
Internal  maxillary  vein 
-77- — \~r  Occipital  vein 
^ff—  Temporo^mazillary  rein 
Posterior  auricular  vein 

Occipital  lymphatic  gland* 
Sterno-mastoid  lymphatic 

glands 

Communication  beltceen 
facial    and    external 
jugular  rein* 
Svbmarillary  lymphatic 

glands 

Internal  jugular  rein 
Posterior  external  jugular 

vein 
External  jugular  rein 


Superficial  cervical  chain 
of  gland* 


Trapeziua 


Transrerte 
cervical  rein 

•  Supratcapular 
rein 


Jugulo-cephalic 
vein 


Superficial  branches  of  cervical  plexus.     (See  Fig.  25.) 

Transverse  cervical. 

Supra-sternal. 

Supra -clavicular. 

Supra-acromial. 

Great  auricular. 

Small  occipital. 
Spinal  accessory. 

Study  the  platysma  myoides. 

Carefully  remove  the  platysma  myoides  and  expose  :- 

Superficial  veins  (Fig.  24) : — 

External  jugular. 

Anterior  jugular. 

Posterior  jugular. 


22 


THE  NECK 


Lymphatics  of  the  neck.     (Fig.  24.) 
Superficial  cervical. 
External  jugular. 
Anterior  cervical. 
Submaxillary. 
Submental. 


FIG.  25. — SUPERFICIAL  BRANCHES  OF  THE  CERVICAL  PLEXUS. — (Morns.} 


POSTERIOR 

A  URICULAR 
NER  VE 


FACIAL  NERVE 


INFRAMAXUIB  ULAR 


SUPERFICIAL   CERVICAL 
BRANCHES  OF  SUPER- 
FICIAL CERVICAL 
NERVE 


SUPRASTERNAL 


•  BRANCHES  OF 
}-         GREA  T 
)     AURICULAR 

GREAT  OCCIPITAL 


LESSER  OCCIPITAL 


GREA  T  A  URICI'LA  R 
.V  AS  TO  ID  BR.  OR  2nd 

SMALL  OCCIPITAL 
SPINAL  ACCESSORY 


BR.    TO  LEV  ATI  IR 

\si;ri.i  sr.\i>rr..E 

SUPRA-  A  CROMIAL 
SUPRACLAVICCLAR 


BRANCHES  TO 

TRAPEZIUS 


SU PR AC LA  VIC  ULAR 


Study  deep  cervical  fascia. 
Triangles  of  the  neck  :— 

Anterior  triangles. 

Digastric  or  submaxillary. 
Carotid  superior  or  carotid. 
Carotid  inferior  or  muscular. 
Posterior  triangles. 
Occipital. 
Subclavian. 

Complete  the  dissection  of  the  posterior  triangle  before  doing  any 
further  dissection  on  the  anterior  triangles. 


THE  NECK 


In  posterior  triangle  expose  and  study:  — 
Arteries  :  — 

Supra-scapular  (A.  transversa  scapula). 

Transverse  cervical. 

Expose  third  portion  of  subclavian  artery  by  pushing  aside 
scalenus  anticus  and  medius  muscles. 


FIG.  26.  —  REGION  OF  THE  THIRD  PART  OF  THE  SUBCLAVIAN  ARTERY. 

(Morris.)     Also  see  Fig.  28. 
(The  shoulder  represented  depressed.) 


(Bellamy.) 


\ 


Splenius 

Lerator  anguli  scapulae 
Scalenus  posticus 

f'ERFlCIAL  DE- 
.S'  /:  \DIXG  BRA  -V  'H 
1 1  r  THE  CER  I  '1C A  L 
PLKXU8 

ft  RA  fill  A  L   PL  EX  f  'I 
Transrtrtali*  colli  artery 

(deep) 

First  serration  of  serratus 
magnus 


PHRESIC  XER  VE 

Scalenus  anticus 


First  serration  of  serratus  magnus 
v-~  Siibclarian  vei» 

Suprascapular  artery 
Svbclarian  artery 

Stiprascapuiar  rein 
Costo-coracoid  membrane  and  cephalic  »et» 

Xerves  (see  Figs.  25  and  28): — 
Cervical  plexus. 

Superficial  branches  have  been  studied. 
Deep  branches: 
External. 
Muscular. 
Communicating. 
Internal. 
Muscular. 
Communicating. 

Phrenic — lies  on  anterior  surface  of  scalenus  anticus. 
Spinal  accessor}-. 
Muscles: — 

Sterno-cleido-mastoid.  Scalenus  medius. 

Omo-hyoid.  Scalenus  posticus. 

Trapezius.  Splenius. 

Scalenus  anticus.  Levator  anguli  scapulae. 


24  THE  NECK 

DEMONSTRATION  VI. 

In  anterior  triangles  of  the  neck. 

Note  that  the  carotid  artery  lies  just  beneath  the  anterior  border  of 
the  sterno-mastoid  muscle. 

Cut  the  clavicle  at  its  inner  third,  disarticulate  sternal  end,  turn  it  up  with 
the  sterno-mastoid  muscle,  taking  care  not  to  remove  any  of  the  structures 
beneath  the  muscle. 

Study  the  cervical  fascia. 

Lying  on  or  in  the  sheath  of  the  carotid  artery,  internal  jugular  vein, 
and  vagus  nerve  you  will  find  the  descendens  hypoglossi  nerve.  Trace  it 
up  to  the  hypoglossal  nerve  and  down  to  the  communication  with  the  com- 
municantes  hypoglossi,  forming  the  anas.  (Fig.  27.) 


FIG.   27. — CENTRAL  LINE  OF  NECK. — COURSE  AND  RELATIONS  OF  COMMON  CAROTID 

'    ARTERY. — (Holden.} 


Occipital  a. 

Hypoglossal 

n. 

Descendens 
hypoglossi  n . 

2d  cervical  n.  — 

Superior   thy-  _ 
roid  a. 

3d  cervical  n. 

Communicans 
hypoglossi  n. 
Crico-thyroid 

m. 

Internal  jugu- 
lar v. 

Common  car- 
otid a. 


Digastricus. 


THE  XECK 


FIG.  28. — THE  COMMON  CAROTID,  THE  EXTERNAL  AND  INTERNAL  CAROTID  AND  THE  SUB- 

CLAVIAN  ARTERIES  OF  THE  RIGHT  SIDE  AND  THEIR  BRANCHES. — (Morris.) 
(From  a  dissection  by  Dr.  Alder  Smith  in  the  Museum  of  St.  Bartholomew's  Hospital.) 

Stylo-gloss  ua 


INFERIOR  DESTAL  SERVE 
CHORDA  TYMPASI 
FACIAL  SERVE 
Internal  maxillary  artery 
Stylo-hyoid,  turned  up 
Digastricus,  turned  up 
Temporal  artery 


Submental  artery 
facial  artery 

MYLO-HYOID  SERVE 
LOWER  JAW.  TURNED  UP 


Posterior  auricular  artery 
Internal  jugular  rein 


SECOS'n  CERVICAL 

SERVE 
$PI\A  I.  A  CCESSOR  Y  N 

SERVE 

Bectus  capitis  anticus  major 

Stylo-pharyngeus  muscle 

OF  SYMPATHETIC 

"it-PHAR.  SERVE 

Sterno-mastoid,  reflected 

Occipital  artery 

Internal  carotid 

Lerator  anguli  scapulae 

THIRD  CERVH:  SERVE 

L>E«  -ESl>f-:S.<  HYPIJ- 

SSI  SERVE 

External  carotid 

Inferior  constrictor 


l\\'.  HYPOGLOSSI 
FO  UR  TH  f  'ER  I  '.  SER  f  'E 
Atcending  cerrfcal  artery 
ZPISA  L  A  C>.  "ESSOR  Y 
PHRESIC  SER  VE 
Scalenus  anticus 
Levator  anguli  scapulae 

FIFTH  CERV.  SERVE 
Scalenus  medius 
r'F.RVIi-AL  PLEXUS 

\7>/;.V.S-  BRASfff 
PSEl'UOGASTRIC 

SERVE  ^^ 

DRAfHlAL  PLEXl  ~ 


Internal  jugular  rein 
Superficial  cerrical  artery 

Suprateapular  artery 

Serratus  magnus 

Coraco-brachialis 


Suprateapular  artery  giren  of  from  third 
part  of  tubclarian 

Posterior  scapular  artery 
Sl'PRASCAPl'LAR  SERVE 

Humeral  thoracic  artery 
Posterior  belly  of  orno-hyoid,  drawn  do 


SL'B.V AXIL  LAKY  GANGLION 
G  US  TA  TORY  SER  I  ~E 
SUBMAXIUART  DUCT 
SUBUAX1LURY  6UND 
TONGUE 

1IYPOGLOS.  SERVE 
Ranine  artery 

Genio-hyo-glossus 
Sublingual  artery 

Lingual  artery 
Artery  offraenvm 
LOWER  JAW 

Genio-hyoid 

Hyo-glosaus 
Lingual  artery 
Hyoid  branch 
Mylo-hyoid  muscle 
Thyro-hyoid  membrane 

SUPERIOR  LARYS- 
GEAL  SERVE 

Superior  iaryngtal  artery 

Thyro-hyoid 

Superior  thyroid  artery 

Omo-hyoid 

EX  TERSA  L  L  A  R  YA'- 

GEAL  SERVE 
THYROID  GLAND 

Sterno-hyoid 
Common  carotid 
Sterno-thyroid 

Vertebral  artery 
Inferior  thyroid  artery 
Anterior  jugular  rein 
Common  carotid 
CLAVICLE 

Vertebral  rein 

BRACIHAL  PLEXUS 
(SEVESTH  CERVIC.) 

Subclarian  artery 

Fectoralis  major, 
reflected 


\     Transverse  cerrical  artery 
Subclavius,  reflected 

BRACHIAL  PLEXUS  (EIGHTH  CERVICAL) 
Pectoral  branch  of  acromial  thoracic  artery 
Subclarian  rein 
Pectoralis  minor 


Expose  the  carotid  artery,  internal  jugular  vein,  and  vagus  nerve,  and 
note  their  relative  position  to  each  other  and  to  surrounding  structures. 

Expose  the  sympathetic  gangliated  cord  behind  the  carotid  sheath. 
(See  Figs.  28  and  29.) 

Trace  the  superior  laryngeal  nerve  to  the  superior  border  of  thyroid 
cartilage;  note  its  division  into  internal  and  external  branches. 

Xote  the  division  of  the  common  carotid  into  the  external  and  internal 
carotid. 


26 


THE  NECK 


Now  expose  and  study  the  branches  of  the  external  carotid .  (See  Fig.  28.) 
Expose  the  subclavian  artery  and  its  branches.     (See  Figs.  26  and  28.) 
What  position  does  this  artery  have  in  relation  to  the  subclavian  vein, 
vagus  nerve,  and  scaleni  muscles? 

Expose  the  inferior  or  recurrent  laryngeal  nerve  lying  behind  the  com- 
mon carotid  artery  and  in  the  groove  between  the  trachea  and  oesophagus. 


FIG.   29. — DISTRIBUTION   OF   THE    PNEUMOGASTRIC    NERVE, 

(Krause.)     (Morris.} 


VIEWED     FROM     BEHIND. 


Stylo-hyoid 


Ligamentum  pharyngeum 
XI 


Posterior  belly  of 
digastric 


Sterno-mastoid 

Rectus  capitis 
anticus  major 

Stylo-pharyngeus 

Stylo-glossus 

Internal  pterygoid 

XIT'ERIOR 
CERVICAL 
GANGLION 

Middle  constrictor 

Common  carotid 
artery 

Inferior  constrictor 

GANGLION 

THYROIDEUM 
(VARIETY) 

THYROID  GLAND 


Infa-io?  thyroid 
artery 

Subc/arittii  iirli'rii 


RECURRENT 
LARYNGEAL 
NER  VE 


Thoracic  aorta 


Cru3  of  diaphragm 


Internal  carotid 

in  /••;•// 

' 


SYMPATHETIC 
Occipital  urti'ry 

Posterior  belly  of 
digastric 


DESCENDEN8 
HYPdGLOSSI 

<'<iiiiiii<n<  carotid 
artery 

-    Sterno-raastoid 


TWIG  or 
RECURRENT 

LARYNGEAL  TO 

I'llARYSGEAL 

PLEXUS 


Thyroid  <u'M 


INFERIOR 
CERVICAL 
GANGLION 

RECURRENT 
LARYXGEAL 

['LEXL'S  GULJE 


RIGHT 
PNEUMOGA8TRIG 


THE  NECK 


27 


Search  carefully  for  the  thoracic  duct  on  the  left  side  as  it  enters  the 
subclavian  vein  near  the  junction  with  internal  jugular.     (Fig.  30.) 


FIG.  30. — THE  SUPERIOR  AND  INFERIOR  VEN.E  CAVJB,  THE  INNOMINATE  VEINS,  AND  THE 

AZYGOS  VEINS. — (Morris.) 


Right  common  carotid 

artery 

Right  internal  jugular 
rein 


RIGHT  LYMPHATIC  DUCT 

Innominate  artery 

RIGHT  PffBUMO- 

GASTRIC  XERl'E 

Right  innominate  vein 

Internal  mammary  vein 

Trunk  of  the  perifardiac 
and  thymic  veins 
Vena  cata  superior 


Vena  azygos  major    


Vena  azygos  minor,  cross- 
ing spine  tfj  enter  vena 
major 


Hepatic  reins 


Vena  cata  inferior 

Right  phrenic  artery 
Cailiac  axis 

Right  middle  suprarenal 
artery 


Right  spermatic  artery 
Right  spermatic  rein 


Left  common  carotid 

artery 

LEFT  PNMUMOGA& 
TRIG  SERVE 

THORACIC  DUCT 

Left  innominate  vein 

Left  subclavian  artery 


Left  superior  intercostal 
rein 

RECURRENT 
LARYSGEAL 
XER  YE 


Vena  azygos  tertius 

(ESOPHAGUS 

Left  upper  azygos  vein 

CEsophageal  branches 
from  aorta 

Vena  azygos  minor 


THORAC  C  DUCT 


Left  phrenic  artery 

Left  middle  suprarenal 
artery 

RECEPTACULUM  CHYLI 

Superior  mesenteric 
artery 

Left  ascending  lumbar 
rein 

Left  spermatic  vessel* 


Inferior  mesenteric 
artery 


In  the  anterior  triangle  you  have  the  following  structures,  some  of 
which  have  been  exposed  and  studied.     Clean  and  study  each  carefully 
and  note  the  position  each  bears  to  the  surrounding  structures: — - 
Xerves : — 

Descendens  hypoglossi. 
Hypoglossal. 

Communicantes  hypoglossi. 


28  THE  NECK 

Ansa  hypoglossi. 
Vagus  or  pneumogastric. 

Pharyngeal. 

Superior  laryngeal. 

Inferior  laryngeal. 
Phrenic. 
Sympathetic. 

Arteries : — 

Common  carotid. 
External  carotid. 

Superior  thyroid. 

Lingual. 

Facial. 

Ascending  pharyngeal. 

Occipital. 

Posterior  auricular. 
Internal  carotid. 

Veins : — 

Internal  jugular. 

Tributaries  to  internal  jugular. 

Review  veins  of  head  and  neck. 
Thoracic  duct, — its  termination. 
Right  lymphatic  duct. 
Review  lymphatics  of  head  and  neck. 

Subclavian  artery. 

Thyroid  axis  (A .  truncus  thyreo-cervicalis)  and  branches. 

Vertebral. 

Internal  mammary. 

Superior  intercostal  (A.  truncus  costocervicalis] . 

Subclavian  vein. 

Tributaries  to  internal  jugular. 

Muscles  (see  Fig.  27  and  34):— 
Omo-hyoid. 
Sterno-hyoid. 
Sterno-thyroid. 
Thyro-hyoid. 
Scaleni. 


THE  XECK 


29 


FJG.  31. — DIAGRAM  OF  THE  SUPERFICIAL  LYMPHATIC  VESSELS  AND  GLANDS  OF  THE  HEAD 
AND   NECK.     (After  Drawing  by  Dr.    Francis  R.    Sherwood.)     (Morris.) 


Ext.  part  of  eyel 
Outer  part  of  cheek 
Part  of  face 


Occipital  region 


Face  and  Lips  superficial 
Nose  and  floor  of  mcut 

Ant.  part  of  tongue 

Sublingual 

Submaxillary 

Part  of  parotid 


Submaxillary  glands  8  to 


Deep  cervical  glands 

Superficial  cervical  glands 


Suboccipital  gland* 


Post.  Auric,  or 
Sterno-mastoid  glands 


Efferent  vessels  to  deep  cervical 


FIG.  32.- — DIAGRAM  OF  THE  DEEP  LYMPHATIC  VESSELS  AND  GLANDS  OF  THE  HEAD  AND 
XECK.     (After  Drawing  by  Dr.  Francis  R.  Sherwood.)     (Morris.') 


Spheno-maxfflary  Fossa 

Temporal  Fossa 

Orbit 
Nose 


Upper  part  of  pharynx  and  pal 

Internal  maxillary  glands  3  to 


Efferent  vessels  from 
submaxJIlary  glands 


Middle  of  pharynx 
Lower  part  of  Larynx 


Upper  and  post,  part  of  Tongue 


Interior  of  Cranium 

Inner  and  posterior  part  of  Nose 


Trachea  )  u 
Esophagus) 


CEs 

Lower  part  of  Thyroid  body 

Efferent  vessels 


Upper  part  of  pharynx 

Deep  muscles  of  neck 
(prevertebral) 

Posterior  pharyngeal  glandr 


Deep  cervical  glands 


Deep  muscje* 


nd  L.  Lymphatic  ducts 


Thyroid  body  or  gland. 

Position  and  general  description. 

Lobes. 

Isthmus. 


M.  levator  glandulse  thyroidae. 
Accessory  thyroids. 
Arteries  and  veins. 


FIG.  33. — VIEW  OF  THYROID  BODY. — (Morris.) 

SMALLER  CORNU  OF  HYOID  BONE 

BODY  OF  HVOID  BONE 


Thyro-hyoid  ligament 


THYROID  CARTILAGE 


THYROID  ISTHMUS 


Thyro-hyoid  membrane 


Thyro-hyoid  muscle 


Inferior  constrictor 


Sterno-thyroid  muscle 


Median  portion  of  crieo- 
thyroid  membrane 


-    Crico -thyroid  muscle 


LATERAL  LOBE  OF  THYROID  BODY 


SECTION  THROUGH  CARTILAGES 


FIG.  34- — THYROID  BODY,  WITH  MIDDLE  LOBE  AND  LEVATOR  MUSCLE. — (Morris.) 


Stylo-hyoid  ligament 


TRACHEA 


EPIGLOTTIS 


BODY  OF  HYOID  BONE 
Thyro-hyoid  ligament 


Thyro-hyoid  membrane 


Levator  glandulae  thyroidea 
THYROID  CARTILAGE 


PYRAMIDAL  PROCESS  OF  THYROID  BODY 


I —  LEFT  LATERAL  LOBE 


THE  NECK 

FIG.  35. — THVMUS  GLAND  IN  A  CHILD  AT  BIRTH. — (Morris.) 


3' 


HYOID  BONE 

Thyro-hyoid  membrane 
THYROID  CARTILAGE 


Sterno-thyroid  muscle 
Crico-thyroid 
membrane 

Crico-thyroid  muscle 
THYROID  BUND 

Right  common  carotid 

artery 
RIGHT  pyEl'MO- 

i:i<- yERVK 

•  lernal  jugular 
MSN 

Level  of  sternum 

SECTION  OF  CLAYICLE 
SECTION  OF   FIRST  RIB 


SECTION  OF  STERNUM 


Thyro-hyoid  muscle 

Lateral  portion  crico- 
thyroid  membrane 

Omo-hyoid  muscle 
Sterno-mastoid  muscle 

CRICOID  CARTIUGE 
FIRST  RIN6  OF  TRACHEA 

TRACHEA 

Left  suspensory 

ligament 
LEFT  RECTRREXT 

XER  VE 

(Esophagus 

Lift  innominate  rein 
LEFT  LOBE  OF  TIIYHUS 


Left  inltrnaj  mammary 
artery 


Pericardium 


SECTION  OF  RFTH  RIB 
CARTILAGE 


ENSIFORM  CARTIUGE 


Submaxillary  or  Digastric  Triangle  (Fig.  36). 

Expose  the  following  superficial  structures  only:- 
Submaxillary  gland. 

Do  not  remove  this  gland  now. 
Facial  artery. 
Hypoglossal  nerve. 


THE  NECK 


Muscles : — 

Digastric. 

Stylo-hyoid. 

Mylo-hyoid. 


FIG.  36. — DIGASTRIC  TRIANGLE  AND  CONTENTS. — (Holden.) 


Occipita 


Hypoglossal 


Descendens 
glossi  n. 

Ling 


hypo- 


lala.     


Internal  jugu 
Superior  thyr- 


oid a 


Common  carotid  a.  __ 


ala. 


hyoid  n. 


bmental  ; 


TEMPORAL  AND  PTERYGOID  MUSCLES 


33 


DEMONSTRATION  VII. 

TEMPORO-  AND  PTERYGO-MAXILLARY  REGION. 

Study  the  temporal  fascia  and  remove  it. 

Study  the  masseter  fascia  and  remove  it. 

Study  the  masseter  muscle.     (Fig.  7.) 

Then  cut  the  zygomatic  arch  on  each  side  of  the  masseter  muscle.  The 
posterior  cut  should  be  made  immediately  in  front  of  the  glenoid  fossa;  the 
anterior  cut  should  extend  obliquely  through  the  malar  bone.  Now  turn  the 
bony  arch  thus  cut  with  the  masseter  muscle  down;  observe  the  nerve 
and  artery  which  pass  to  the  muscle  through  the  sigmoid  notch  between 
the  neck  of  the  jaw  and  posterior  margin  of  the  temporal  muscle.  When 
the  nerve  and  artery  are  found  and  studied,  cut  them  and  remove  them 
with  the  muscle. 

Clean  and  study  the  temporal  muscle. 

Then  cut  the  coronoid  process  of  mandible  and  turn  it  up  with  the  tem- 
poral muscle  attached. 

Now  note  the  external  pterygoid  muscle. 


FIG.  37.— (Holder.) 


Clean  and   study  the  external  pterygoid  muscle  with  care  so  as  not 
to  destroy  the  internal  maxillary  artery.     (Figs.  38  and  39.) 


34 


PTERYGOID  REGION 

FIG.  38. — THE  PTERYGOID  MUSCLES. — (Morris.) 


External  pterygoid 


Internal  pterygoid 


flbro-cartilage 


FIG.  39. — SCHEME  OF  LEFT  INTERNAL  MAXILLARY  ARTERY.      (Walsham.)      (Morris.) 


Infraorbital  artery  and  nerve 


Orbital  branch 


Palpebral 
ch 


lpebr 
bran 


Nasal  branch 

Anterior    . 
dental  branch  I 

Labial  branch 

Posterior  dental 

branch 


Alveolar  branch 


Incisive  branch 
Menial  branch 

Submenlal  branch 


Spheno-palatine  branch 

Posterior  or  descending  palatine  branch 
Inline  branch 


'emporal  artery 

Small  meningeal 
artery 

Middle  meningeal 

artery 


Temporal  artery 
Ti/in/iiinic  branch 

Deep  auricular 
branch 

A  I'HICULO-TEM- 
I'OHAL  XKRVK 

Manseteric  brunch 


External  carotid 
artery 


Internal  lateral  or 
spheno-mandibu- 
lar  ligament 

Mtinillbiiltir  or 
htfi'rinr  dental 
artery  and  nerve 


Buccal  branch  with.        Internal  pterygoid  branch 
portion  of  buccal  nerve 
Mylo-hyoidean  branch 


PTERYGOID  REGIOX 


35 


Cut  the  condyle  of  the  mandible,  disarticulate,  and  remove  it,  unthjhe  ex- 
ternal pterygoid  muscle. 

Study  the  temporo-mandibular  articulation. 


FIG.  40. — VERTICAL  SECTION  THROUGH  THE  COXDYLE  OF  JAW  TO  SHOW  THE  TWO]SYXOVIAL 

SACS    AXD   THE    IXTERARTICULAR    FlBRO-CARTILAGE. (Morris.) 


Stylo-mandibular  ligament 


Xext  expose  the  deep  pterygoid  region  by  removing  the  upper  part  of 
the  ramus  of  the  mandible.  Cut  the  ramus  with  saw  and  bone-pliers  im- 
mediately above  the  inferior  dental  foramen.  To  find  the  inferior  dental 
foramen  thrust  a  knife  handle  down  between  the  ramus  and  soft  parts  until 
its  progress  is  arrested  by  the  entrance  of  the  inferior  dental  nerve  and  vessels 
into  the  foramen. 

Expose  the  inferior  dental  vessels  and  nerve  as  far  as  possible  by  cutting 

\y  part  of  the  mandible  with  chisel  and  bone-pliers. 

Cut  the  mandible  at  the  mental  foramen  and  turn  the  piece  cut  off  up,  care- 
fully cutting  the  insertions  of  the  internal  pterygoid  and  mylo-hyoid  muscles 
and  other  structures  beneath  from  the  bone. 

Study  the  internal  pterygoid  muscle.  Xote  its  relation  to  the  ex- 
ternal pterygoid.  Also  note  the  structures  lying  between  these  two  mus- 
cles. . 

Expose  and  study  the  following  structures : — - 

Arteries : — 

Internal  maxillary  and  branches.     (See  Figs.  39  and  41.) 

Veins : — 

Internal  maxillary  and  its  tributaries. 


MAXILLARY  REGION 


Nerves  (Figs.  42  and  43)  :— 

Mandibular  division  of  fifth. 
Recurrent. 
Internal  pterygoid. 
Anterior  portion. 
Temporal. 
Masseteric. 
External  pterygoid. 
Long  buccal. 


Posterior  portion. 

Lingual. 

Inferior  dental. 

Auriculo-temporal. 
Submaxillary  ganglion . 
Otic  ganglion. 
Chorda  tympani. 


FIG.  41. — INTERNAL  MAXILLARY  ARTERY. — (Holden.} 


INCISOR 


Submaxillary  or  digastric  triangle. 

The  superficial  structures  have  been  worked  out. 
Deep  structures: — 
Submaxillary  gland. 
Submaxillary  ganglion.     (See  Fig.  43.) 
Sublingual  gland.     (Fig.  44.) 
Nerves  in  this  triangle : — 

Lingual. 

Inferior  dental. 

Hypoglossal. 

Chorda  tympani. 
Arteries  (see  Figs.  45  and  28):— 

Lingual  and  branches. 

Facial  (a.  maxillaris  externa). 

Inferior  dental.     (Fig.  41.) 


Veins  :— 
Lingual. 
Facial. 


FIG.  42. — DISTRIBUTION  OF  THE  MAXDIBULAR  DIVISION  OF  THE  TRIGEMINAL  NERVE. 

(Henle.)     (Morris.) 


SUB- 

MAXDIBCLAR 
GAXGLIOy 

MENTAL 

BRANCH 


ANTERIOR  TEM- 
PORAL NER  VE 

AL'RICULO-TEM- 
PORAL  SERVE 

POSTERIOR  TEM- 
PORAL SERVE 


NERVE  TO  MAS- 
SETER 


CHORDA   TYM- 
PANI 

MYLO-HYOID 

XERVE 
LiyGUAL 
XER  VE 

INFERIOR 
DEXTAL  SERVE 


FIG.  43. — SHOWING  FIFTH  XERVE.     (Holden.) 


SSKSCftY  ROOT 
MOTOR   HOOT 


AHHICULO  TtMPOHM.  H. 


37 


SUBMA  XILLA R  Y  REGION 

FIG.   44. — THE  SALIVARY  GLANDS. — (Morris.) 


PAROTID  GLAND 


Masseter  muscle 


SOOIA  HAROTIDIS 


DUCT  OF  PAROTID 


Bristle  inserted 
into  duct 


Fraenum  linguae 

DUCT  OF  R1VINUS 


SUBLINGUAL  GLAND 


DUCT  OF  SUBMAXILLARY 

GLAND 
Mylo-hyoid  muscle 


Sterno-mastoid 

muscle 

Posterior  belly  of 
digastric  muscle 


SUBMAXILLARY  GLAND, 
DRAWN  BACKWARDS 


Loop  of  fascia 


HYOID  BONE' 


Anterior  belly  of 
digastric  muscle 

DEEP  PORTION  OF  SUBMAXILLARY  GLAND 


FIG.  45. — SCHEME  OF  THE  RIGHT  LINGUAL  ARTERY.      (Walsham.)     (Morris.) 


Descending  palatine  artery 
Falato-pharyngeus 

TONSIL 

Ascending  palatine  branch 

of  facial 
Tonsillar  branch  of  dorsalis 

linguce 

Tonsillar  branch  of  facial 

Stylo-glossus 

Dorsalis  linguce  artery 

le  constrictor 
?AL  NERVE 

Facial  artery 

Posterior  belly  of  digastric 
and  stylo-hyoid 
Supra-hyo'id  branch 

SUP.  LARYNGEALN. 

Infra-hyoid  branch 
Internal  carotid  artery 


Middle  constrictor 
HYPOGLOSSAL  NERVE 


Falato-glossus 


Ranine  artery 


r  thyroid  artery 


External  carotid  artery 
Common  carotid  artery 


Muscles  (Figs.  45  and  46)  :— • 
Mylo-hyoid. 
Hyo-glossus. 
Genio-hyoid. 
Stylo-glossus. 

Genio-hyo-glossus  (m.  genioglossus}. 
Chondro-glossus . 


SUBM AXILLARY 


39 


FIG.  46. — MUSCLES,  VESSELS,   AXD  NERVES  OF  THE  TONGUE. — (Holden.) 


Styloid 
process. 


Glosso- 
pharyngeal  n. 

Hypoglossal  n. 
Occipital  a 

Submandibular 
ganglion. 
Duct  of  sub- 
mandibular 
gland. 
Middle  con- 
strictor m. 

Lingual  a. 

Descendens 
hypoglossi  n. 


.  Chorda  tympani  c . 
.  Gustatory  n. 


Sablin- 
guala. 


40  DEEP  NECK 


DEMONSTRATION  VIII. 
DEEP  DISSECTION  OF  THE  NECK.     (Figs.  28  and  47.) 

Expose  the  ascending  pharyngeal  artery. 

Trace  to  the  base  of  the  cranium  the : — 
Internal  carotid  artery. 
Internal  jugular  vein. 
Vagus  nerve. 
Hypoglossal  nerve. 
Gangliated  cord. 

Note  the  cervical  ganglia  of  the  sympathetic. 

Clean  and  study  the  stylo-pharyngeus  muscle.     Use  care  so  as  not  to 
cut  the  glosso-pharyngeal  nerve,  which  winds  around  the  posterior  and 
external  surface  of  the  stylo-pharyngeus  muscle. 
Trace  and  study  the  glosso-pharyngeal  nerve. 
Branches  of  seventh  nerve  at  its  exit  through  stylo-mastoid  foramen. 

Digastric. 

Stylo-hyoid. 

Posterior  auricular. 

Note  the  position  of  the  internal  carotid  artery  in  relation  to  the  follow- 
ing structures:— 
Muscles : — 

Middle  constrictor  of  the  pharynx. 

Superior  constrictor  of  the  pharynx. 

Stylo-pharyngeus. 

Stylo-glossus. 

Ascending  pharyngeal  artery. 
Glosso-pharyngeal  nerve. 


DEEP  NECK 


FIG.  47. — SCHEME  OF  RIGHT  ASCENDING  PHARYNGEAL  ARTERY.     (Walsham.)     (Morris.} 

The  internal  carotid  artery  is  hooked  aside. 

Also  see  Figs.  30   and  50. 


Meningtal  branch  pasting  through 
middle  lacerated  foramen 

Tympanic  branch 

Men  ingtal  branch  patting  through 

jugular  foramen 

Men  ingeal  branch  pasting  through 
anterior  candy loid  foramen 


Stylo-pharyngeus 


GLOSSO-PfTA  R  YXGEA  L 
*E£  YE 

Occipital  artery 
Rectua  capitis  anticus 

major 
Ascending  pharyngeal 

artery 

Middle  constrictor  of 
pharynx 

SY.VPA  THE  TIC  .\ERTE 
Internal  carotid  artery 
External  carotid  artery 


Intracranial  part  of  internal 
carotid 


Intraosseous  part  of  internal 
carotid 

Leva  tor  palati 
Palatine  branch 


Buccinator  muscle 


Superior  constrictor 
of  pharynx 

Pterygo-maxillary 
ligament 

Stylo-glossus 


Ascending  palatine  branch 
of  facial  artery 

Tonrillar  branch  of  facial  artery 

Hyo-glossus 
Facial  artery 


Lingual  artery 
Superior  thyroid  artery 


Common  carotid  artery 


42  ANTERIOR   VERTEBRAL  AND  PHARYNX 

DEMONSTRATION  IX. 

Remove  the  anterior  part  of  the  skull  with  pharynx  attached  by  dividing 
the  trachea  and  oesophagus  about  one  inch  below  the  larynx.  Draw  the  trachea 
and  (esophagus  forward  and  separate  them  from  their  arterial  and  vertebral 
attachments.  With  a  saw  cut  inward  along  the  posterior  border  of  petrous  por- 
tion of  temporal  bone,  passing  behind  the  jugular  foramen.  Divide  the  basilar 
part  of  occipital  bone  with  a  chisel. 

Wrap  the  part  thus  severed  in  a  wet  cloth  and  lay  it  aside  while  the  anterior 
vertebral  region  is  being  dissected. 


ANTERIOR  VERTEBRAL  REGION. 

Expose  and  study  the  following  structures: — 
Muscles  (Fig.  48)  :— 

Longus  colli. 

Rectus  capitis  anticus  major. 

Rectus  capitis  anticus  minor. 

Rectus  capitis  lateralis. 

Scaleni. 

Arteries  (Fig.  49) : — 

Vertebral  and  branches. 
Deep  cervical. 

Veins : — 

Vertebral  and  tributaries. 

Nerves : — 

Trunks  of  cervical  plexus.     (Fig.  50.) 
Trunks  of  brachial  plexus. 

Study  articulations  of  head. 
Atlas  with  occiput. 
Atlas  and  axis. 
Axis  and  occiput. 

PHARYNX.     (Figs.  51  and  52.) 

Moderately  distend  the  walls  of  the  pharynx  with  tow. 

Study  a  description  of  the  pharynx.  Then  clean  and  study  the  in- 
ferior, middle,  and  superior  constrictor  muscles. 

Study  the  pharyngeal  aponeurosis. 

Now  open  the  pharynx  by  a  posterior  median  incision.     (Fig.  53.) 

Study  the  interior  of  the  pharynx.  Examine, — posterior  nares,  open- 
ing of  Eustachian  tube,  opening  into  larynx,  pharyngeal  recess  or  fossa 
of  Rosenmuller,  pharyngeal  tonsil,  pharyngeal  bursa,  base  of  tongue  and 
beginning  of  oesophagus. 


AXTERIOR  VERTEBRAL  REGIOX 


FIG.  48. — THE  MUSCLES  OF  THE  FRONT  OF  THE  NECK. — (Morris.) 


Rectus  capitis  anticua 
minor 

Rectus  capitis  lateralis 


Rectus  capitis  anticus 
major 


Origin  of  rectus  capitis 
anticus  major 


Scalenus  medius 


Scalenus  antious 


Scalenus  posticus 


Rectus  capitis  later- 
alis 

Rectus  capitis  anti- 
cus minor 


Intertransyersalis 
anterior 


Intertransversalis 
posterior 


Longus  colli 


Insertion  of  scalenus 
anticus 


Sealenus  medius 


Scalenus  posticus 


44 


DEEP  NECK 


FIG.  49. — SCHEME  OF  THE  LEFT  VERTEBRAL  ARTERY.      (Walsham.)      (Morris.} 
The  internal  jugular  and  vertebral  veins  are  hooked  aside  to  expose  the  artery. 


Right  posterior  cerebral  artery 

Left  posterior  cerebral  artery 

Basilar  artery 

BASILAR  PROCESS,  OCCIPITAL  BONE 


Inlracranial  portion  of  vertebral  artery 
Rectus  capitis  lateralia  muscle 

FIRST  CER  VIC  A  L  NER  VE 

Commencement  of  vertebral  vein 

SECOND  CERVICAL  NERVE 

Vertebral  plexus  of  reins 

THIRD  CERVICAL  NERVE 

Vertebral  portion  of  vertebral  artery 
FOURTH  CERVICAL  NERVE 

Vertebral  plexus  of  veins 
FIFTH  CERVICAL  NERVE 

SIXTH  CERVICAL  NERVE 

Inferior  thyroid  artery 

Longus  colli  muscle 

Cervical  portion  of  vertebral  artery 

Internal  jugular  vein,  hooked  a  little 
aside 

Vertebral  re  hi,  cut 
Subclavian  artery 


Right  and  left  supe- 
i  i</r  cerebellar 
arteries 

OCCIPITAL  BONE 


Rectus  capitis  pos- 
ticus  minor  mus- 
cle 


Occipital  portion  of  vertebral  artery 


Arleria  princeps  cervicis 


Semispinalis  colli  muscle 

Deep  cervical  artery 

Scalenus  anticus  muscle,  cut 
Thyroid  axis,  hooked  a  little  aside 
Siibclavian  vein 


DEEP  NECK 


45 


FIG.  50. — DIAGRAM  OF  THE  CERVICAL  PLEXUS. — (Morris.) 


STERNO-MASTOID 
SMALL  OCCIPITAL 


on  E.I  T 

A  URICL'LAR 


SCA  LEX  US 
MEDIUM 


SPINA  L 
ACCESSORY 


TRANSVERSE 

CERVICAL 


S^A  LE.VT'S 

MED  1 1  \ 

LEVA  TOR 
SCA  PULJE 

SYMPATHETIC 


RECTUS  CA  PITTS  ANTICUS 

MAJOR 
RECTUS  CAPITIS  ANTICUS 

MINOR 
RECTUS  CAPITIS  LATER ALIS 


HYPOGLOSSAL  NERVE 

SUPERIOR  CERVICAL 
SYMPATHETIC  GANGLION 

LONG  US  COLLI 
RECTUS  CAPITIS  ANTICUS 
MAJOR 


GENIO-HYOID 
THYRO-HYOID 

LONG  US  COLLI 
RECTUS  CAPITIS 
ANTICUS  MAJOR 
DESCEND  ENS 

CERVICIS- 
O3IO-HYOID 

COMXUNICANS 

CERVICIS 
LONG  US  COLLI 

STERNO-HYOID 
RECTUS  CAPITIS 
ANTICUS  MAJOR 
SCA  LENUS 
A  NTICUS 
STKR  NO- 
THYROID 
OMO-HYOID 


SCA  L  EN  US  MED  I  US 
LEVATOR  SCAPULM 


TRAI'EZIUS 


SUPRA-  SUPRA- 

A  CROMIA L       CLA  J 'ICULA  R 


SUPRASTERNAL 


46  THE  PHARYNX 

FIG.   51. — SIDE  VIEW  OF  THE  MUSCLES  OF  THE  PHARYNX. — (Holden.) 


Obicularis  oris 

Pterygo-mandibular 
ligament. 


-  Glosso-pharyngeal  n. 

-  Stylo-pliaryngeus. 


Mylo-hyoideus. 

Os  hyoides. 

Thyro-hyoid  ligament. 

Pomum  Adami. 


Cricoid  cartilage.  

Trachea. 


Superior  laryngeal 
n.  and  a. 


External  laryngeal  n. 
-   Crico-thyroideus. 

Inferior  laryngeal  n. 
—  (Esophagus. 


FIG.   52. — VIEW  OF  THE  CONSTRICTOR  MUSCLES  FROM  BEHIND. — (Holden.) 


THE  PHARYNX 


47 


p1G     ro — VIEW  OF  MUSCLES  OF  SOFT  PALATE,  AS  SEEN  FROM  WITHIN  THE  PHARYNX. 


(Modified  from  Bourgery.)      (Morris.) 


Levator  palati 


Azygos  uvulae 
Hamular  process 


Palato- 
pharyngeus 


EUSTACHIAN  TUBE 


Levator  palati 


Palato-pharyngeus 


Superior  constrictor 


Crico-arytenoideus 
posticus 


Thyroid  cartilage 


Cricoid  cartilage 


(ESOPHAGUS 


48  PALATE,  MOUTH,  TONGUE,  ETC. 

PALATE. 

Study  description  of  hard  and  soft  palate. 
Soft  palate:— 

Anterior  palatine  arch  or  pillar. 

Posterior  palatine  arch  or  pillar. 

Tonsillar  recess. 

Isthmus  of  fauces. 

Uvula. 
Dissect  out  and  study  the  following  muscles  (Fig.  53)  :— 

Palato-pharyngeus. 

Palato-glossus. 

Levator  palati  (M.  levator  veli  palatini}. 

Tensor  palati  (M.  tensor  veli  palatini}. 

Azygos  uvulae  (M.  wuulaz). 

Salpingo-phary  ngeus . 
Tonsils, — faucial. 

Their  location  and  description. 

Describe  the  arteries,  veins,  and  nerves  of  the  pharynx,  palate,  and 
tonsils. 

MOUTH. 

Study  a  description  of  mouth. 

TEETH. 

General  description. 
Temporary  or  milk  teeth: — 

How  many? 

At  what  ages  do  their  eruptions  occur? 
Permanent  teeth. 

How  many? 

At  what  ages  do  their  eruptions  occur? 
What  is  the  arterial  and  nerve  supply  of  the  teeth? 

TONGUE. 

General  description. 
Muscles  of  tongue:— 

Extrinsic.     (See  Fig.  60.) 

Hyo-glossus. 

Genio-hyo-glossus. 

Stylo-glossus. 

Palato-glossus. 

Part  of  sup.  constrictor. 
Intrinsic.     (See  Fig.  60). 

Lingualis  superior. 

Lingualis  inferior. 

Transverse  fibres. 

Vertical  fibres. 
What  is  the  arterial  and  nerve  supply  of  the  tongue? 


THE  TOXGUE 


49 


fFic.  54. — DORSUM  OF  THE  TONGUE. — (Morris.) 

EXTREMITY  OF  CORNU  OF       False  vocal  cord  LOWER  END  OF  PHARYNX 

HYOIO  BONE 

SUPERIOR  CORNU  OF  THYROID\ 
CARTILAGE 


LATERAL  GLOSSO- 
EPIGLOTTIDEAN  FOLD 


ANTERIOR  WALL  OF  THE 
PHARYNX 

CORNICULUM  LARYNGIS 
CUNEIFORM  CARTILAGE 
SINUS  PYRIFORMIS 

True  vocal  cord 
EPIGLOTTIS 


MEDIAN   GLOSSO- 
EPIGLOTTIDEAN  FOLD 


POSTERIOR  PILLAR  OF  FAUCES 


CIRCUMVALLATE  PAPILL/E 


FUN6IFORM  PAPILLC 


THE  TONGUE 


FIG.  55. — UNDER  SURFACE  OF  THE  TONGUE  WITH  MUSCLES. — (Morris.) 


FR/ENUM  LINGU/E 


LingualiB  inferior 


Hyo-glosBus 


Qenio-hyoid 


Mylo-hyoid,  reflected 


Sterno-hyoid 


Lingualis  inferior 


Genio-hyo-elossu» 


—  Stylo-glossus 

—  Hyo-glosaua 
BODY  OF  HYOID  BONE 
Oenio-hyoid 


THYROID  CARTILAGE 


THE  LARYNX 


LARYNX. 


General  description. 

Note  its  position,  and  its  relation  to  the  pharynx. 


FIG.   56. — FRONT  VIEW  OF  THE  CARTILAGES  OF  THE  LARYNX.      (Modified  from  Bourgery 

and  Jacob.)     (Morris.) 


BODY  OF  HYOID  BONE 
Thyro-hyoid  ligament 

Cartilage  triticea 
Foramen  for  superior 

laryngeal  nerve 
Median  portion  ol  thyro- 

hyoid   membrane 

SUPERIOR  CORNU  OF  THYROID 

CARTILAGE 

MEDIAN  NOTCH  OF  THYROID 
CARTILAGE 

Fomum  Adami 


OBLIQUE  LINE  OF  THYROID 
CARTILAGE 


Crico-thyroid  membrane 


THIRD  RING  OF  TRACHEA 


Note  the  following: — 

Connection  with  the  tongue.     (Fig.  54.) 

Median  glosso-epiglottic  fold. 

Lateral  glosso-epiglottic  fold. 

Epiglottic  vallecula. 
Superior  aperture  of  larynx.     (Fig.  54.) 

Epiglottis. 

Aryteno-epiglottic  fold. 

Cuneiform  cartilage. 

Carniculum  laryngeus. 

Inter-arytenoid  fold. 

Sinus  pyriformis. 

Lower  end  of  pharynx. 
Inside  of  larynx. 

Cushion  or  tubercle  of  the  epiglottis. 

Vocal  process  of  arytenoid  cartilage. 


THE  LARYNX 


FIG.  57. — SIDE  VIEW  OF  THE  CARTILAGES- OF  THE  LARYNX.      (Modified  from  Bourgery  and 

Jacob.)     (Morris.) 


Thyro-hyoid  membrane 


SUPERIOR  BORDER  OF  THYROID 


Crieo-thyroid  muscle 
Crico-thyroid  membrane 
(median  portion) 

Crico-thyroid  muscle 


THIRD  RING  OF  TRACHEA 


Thyro-hyoid  ligament 

CARTILAGO  TRITICEA 


-SUPERIOR  CORNU 


Superior  tubercle 
Stylo-pharyngeus  and 
palato-pharyngeus 

Thyro-hyoid  muscle 


Sterno-thyroid  muscle  and 
inferior  tubercle 


Inferior  constrictor 


FIG.  58. — POSTERIOR  VIEW  OF  THE  LARYNX,  WITH  THE  MUSCLES  REMOVED. — (Holden.) 
E.,  Epiglottis  cushion  (W.);  L.  ar.-ep.,  Aryteno-epiglottic  fold  or  ligament;  M.m.,  Mem- 
brana  mucosa;  C.  W.,  Cartilage  of  Wrisberg  or  cuneiform;  C.  S.,  Cartilage  of  Santorini 
or  cornicula  laryngis;  C.  aryt.,  Arytenoid  cartilage;  C.  c.,  Cricoid  cartilage;  P.  m., 
Muscular  process  or  external  angle;  L.cr.-ar.,  Cricoarytenoid  ligament;  C.  s.,  Superior 
cornu;  C.  i.,  Inferior  cornu  of  the  thyroid  cartilage;  L.  ce.-cr.  p.  i.,  Posterior  inferior 
cerato-cricoid  ligament;  C.  tr.,  Tracheal  cartilage;  P.  m.  tr.,  Membranous  portion  of 
the  trachea. 


THE  LARYXX 


53 


True  vocal  cords. 

False  vocal  cords. 

Ventricle  of  larynx. 

Rima  glottidis. 

Study  the  cartilages  of  the  larynx.     (Fig.  58.) 

Note  the  articulations  of  the  thyroid,  cricoid,  and  arytenoid  cartilages. 
Clean  and  study  the  muscles:— 
Crico-thvroid. 


FIG.  59. — POSTERIOR  VIEW  OF  THE  LARYNX,  WITH  ITS  MUSCLES. — (Holden.) 
E.,  Epiglottis,  with  the  cushion  (W.);  C.W.,  Cartilage  of  Wrisberg;  C.S.,  Cartilage  of  San- 
torini;  Cart,  eric.,  Cricoid  cartilage;  Cornu  sup.,  Superior  cornu  of  the  thyroid  carti- 
lage; A/,  ar.  tr.,  Transverse  portion  of  the  arytenoideus ;  Mtn.ar.  obi.,  Oblique  portion 
of  the  arytenoideus;  M.  cr.  aryt.  post.,  Crico-arytenoideus  muscle;  Pars  can.,  Car- 
tilaginous rings  of  the  trachea;  Pars  memb.,  Tracheal  membrane. 


Crico-arytenoides  posticus. 

Arytenoides. 

Now  cut  the  thyroid  cartilage  a  little  to  one  side  of  the  anterior  median  line, 
disarticulate  the  inferior  cornu  from  cricoid  cartilage  and  remove  this  part  of 
thyroid  cartilage.     Then  expose  the  muscles: — 
Crico-arytenoides  lateralis. 
Thyro-arytenoides. 
Aryteno-epiglottideus . 
Thyro-epiglottideus . 

Study  closely  the  action  of  the  laryngeal  muscles. 


54 


THE  LARYNX 
FIG.  60. — SIDE  VIEW  OF  THE  MUSCLES  AND  LIGAMENTS  OF  THE  LARYNX. — (Morris.} 

Epiglottis 


Cut  edge  of  hyo-epiglottidean 
ligament 

SECTION  THROUGH  BODY  OF  HYOID 
BONE 

Periglottis 

Cut  edge  of  thyro-hyoid 
membrane 

Thyro-epiglottideus  muscle 


SECTION  OF  THYROID  CARTILAGE 
Thyro-arytenoideus  muscle 


Crico  -  arytenoideus  lateralis 
muscle  (the  pointer  crosses 
crico-thyroid  membrane.) 

CRICOID  CARTILAGE 


Aryteno-epiglottidean  fold 
Aryteno-epiglottideus  muscle 


Arytenoideus  muscle 


Crico-arytenoideus  posticus 


Recurrent  laryngeal  nerve 


FIG.  61. — NERVES  OF  THE  LARYNX   (POSTERIOR  VIEW.) — (Morris.} 

FORAMEN  C/ECUM 
BASE  OF  TONGUE 


GREATER  CORNU  OF 

HYOID  BONE 
CARTILAGO  TRITICEA 


SUPERIOR      CORNU      OF 
THYROID  CARTILAGE 


BRANCH  TO  LATERAL 
CRICO  •  ARYTENOID 
AND   THYRO-ARYTE- 
JfOID  MUSCLES 
BRANCH  JOINING  THE 
SUPERIOR       LARYN- 
GEAL NERVE 
Crico-arytenoideus 
posticus  muscle 
INFERIOR    CORNU    OF 
THYROID  CARTILAGE 


EXTERNAL  LARYN- 
GEAL NERVE 

IN  TERN  A  LLAR  YN- 
GEAL  NERVE 

Cut  edge  of  thyro- 
hyoid  membrane 


Arytenoideus  muscle 


RECURRENT 

I,M:YNGEAL 

NER  VE 


THE  LARYXX 


55 


Study  the  thyro-hyoid  membrane,  crico-thyroid  membrane,  infenor 
thyro-arytenoid  ligament,  superior  thyro-arytenoid  ligament,  true  vocal 
cords,  rima  glottidis,  ventricle,  false  vocal  cords,  laryngeal  pouch  or  sac- 
culus  laryngis,  and  the  mucous  membrane. 

Describe  the  nerve  supply  of  the  larynx  (See  Fig.  61): — 
Superior  laryngeal. 
Inferior  or  recurrent  laryngeal. 
Describe  the  arteries  of  the  larynx  (See  Fig.  62) : — 
Branches  of  superior  thyroid. 
Branches  of  inferior  thyroid. 
Dorsalis  lingual. 


FIG.  62. — SCHEME  OF  LEFT  SUPERIOR  THYROID  ARTERY.  (Walsham.)  (Morris.) 

Facial  artery 


Lingual  artery  — 


Supra-hyoid  branch 
Infra-hyoid  branch 

Superior  laryngeal  bratictt 


Crico-thyroid  branch 


External  carotid  artery 
Ascending pharyngeal  artery 

Internal  carotid  artery 


Sterno-mastoid  branch 


Superior  thyroid  artery 


Common  carotid  artery 


Inferior  thyroid  artery 


SUPRAM AXILLARY  NERVE  AXD  XOSE 


DEMONSTRATION  X. 

SUPRA-MAXILLARY  REGION. 

With  a  saw  cut  through  the  squamous  portion  of  the  temporal  bone  to  within 
one-fourth  of  an  inch  of  the  foramen  rotundum.  With  a  hammer  break  out 
the  portion  of  bone  in  front  of  the  incision.  Then  begin  at  the  Gassenan  gan- 
glion and  trace  out  the  superior  tnaxillary  division  of  the  fifth  nerve  across  the 
spheno -maxillary  fossa  to  the  infra-orbital  canal. 

Deep  in  the  spheno-maxillary  fossa  and  just  below  the  superior  maxil- 
lary nerve  find  Meckel's  ga'nglion.  (Figs.  63  and  66.) 

FIG.  63. — THE  MAXILLARY  NERVE  SEEN  FROM  WITHOUT.      (Beaunis.)     (Morris.) 

AJXTERWR  DENTAL        MAXILLARY  KERVE        ORBITAL  BRAN<  II 

I  \  .MAXILLARY    NERVE 


MECKEL'S  GANGLION 


POSTERIOR  DENTAL 


LOOP  FORMED  BY  MIDDLE  AND  ANTERIOR  DENTAL  NERVES 


Trace  and  study  the  branches  of  superior  maxillary  nerve: — 

Recurrent  meningeal. 

Spheno-palatine . 

Orbital  or  temporo-malar. 

Posterior  superior  dental. 

Middle  superior  dental. 

Anterior  superior  dental. 

Review  the  third  division  of  the  internal'  maxillary  artery. 

NOSE. 

Study  general  description  of  the  nose. 

Open  the  nasal  cavity  by  a  vertical  incision  to  one  side  of  median  line 
so  as  to  escape  the  septum.     (Figs.  64  and  65.) 
Study  the  septum. 

Study  the  turbinate  bones  and  meatuses  and  the  openings  into  each. 
What  is  the  nerve  and  arterial  supply  of  the  nose? 


THE  XOSE 


57 


FIG.  64. — SECTION  SHOWING  BONY  AND  CARTILAGINOUS  SEPTUM. — (Morris.) 
The  dotted  lines  indicate  the  course  of  the  anterior  palatine  canal. 


NASAL  BONE 


Frontal  sinus 


Sphenoidal  sinus 


UPPER  LATERAL  CARTILAGE 

Groove  between  septal 
and  upper  lateral 
cartilage 


LZ.'.i-  LATERAL 


N-P-       -V 

THICKENED  BORDER  OF  CARTILAGE  RESTING  \  Pouch  at  r 

UPOa  AUTERiOR  NASAL  SPINE          Incisive  papilla      \  extremity  of  Sten- 


SEPTAL  CARTILAGE  8on>8  canal 


ORIFICE  OF  EUSTACHIAH 

TUBE 
SOFT  PALATE 


FIG.  65. — SECTION  OF  THE  XOSE.  SHOWING  THE  TURBINAL  BONES  AND  MEATUSES.  WITH 
THE  OPENINGS  IN  DOTTED  OUTLINE. — (Morris.) 


Frontal  sinus 


Orifice  of  middle  ethmoidal  cells 

SUPERIOR  TURBINAL  BONE 

Orifice  of  the  posterior  ethmoidal  cells 
Orifice  of  the  sphenoidal  sinus 
Sphenoidal  sinus 


Orifice  of  frontal  sintu 


UPPER  ORIRCE  OF 
NASAL  DUCT 


OWFICE  OF  EUSTACHIAN 

/        17  \ 

MIDDLE  TURBINAL  BONE  /  \  \ 

INFERlOfi  TURBINAL  BONE       ORIFICE  OF  THE  ANTRUM       ORIFICE  OF  INFUNOIBULUU 


LOWER  ORIFICE  OF  NASAL  DUCT 


THE  NOSE 


FIG.  66. — NERVES  OF  THE  NASAL  CAVITY. — (Morris.) 


NA  SA  L    OLFA  CTOR  Y 
FRONTAL  SINUS          NERVE          NERVE 


OF, FA  CTOR  Y  NEK  VK 
TO  SUPERIOR  TUR- 
BINA  TE  BONE 

SPHENOIDAL  SINUS 


VIDIAN  SERVE 

MECKEL'S 
GANGLION 

DESCENDING 
PA  LA  TINE 

ORIFICE  OF  EUSTACHIAN 
TUBE 


—  NASAL  BRANCHES 


POSTERIOR 

PALATINE 
.  ANTERIOR 

PA  LA  TINE 
MIDDLE  PALATINE 


FIG.  67. — SECTION  OF  THE  MIDDLE  AND  EXTERNAL  EAR. — (Morris.) 


SEMI- 
CIRCULAR 
CANALS 
Membrana 
tympani 


CAVITY  OF 
TYMPANUM 


CARTILAGE 

PINNA 

CARTILAGINOUS   MEATUS 


—  OSSEOUS  MEATUS 


CARTILAGE  OF  EXTERNAL 
MEATUS 


PAROTID  GLAND 


STYLOID  PROCESS 


Internal  carotid 
artery 


CARTILAGINOUS  EUSTACHIAN 
TUBE 


OSSEOUS  EUSTACHIAN  TUBE 


THE  EAR 


59 


EAR. 

External  ear.     (Fig.  67.) 
Pinna  or  auricle. 
Integument. 
Cartilage. 
Ligaments. 
Muscles. 

External  auditory  meat  us. 
Cartilaginous  portion. 
Osseous  portion. 
Skin. 

Middle  ear  or  tympanum. 

Tympanic  Cavity.— This  is  best  opened  for  inspection  by  removing  its 
roof  or  tegmen  tympani.     Make  an  opening  through  the  tegmen  tympani 
external  to  the  elevation  formed  by  the  superior  semicircular  canal.     Re- 
move the  whole  roof  of  the  tympanic  cavity,  and  study  its  ossicles,  walls, 
mastoid  antrum,  attic,  and  Eustachian  tube. 
Internal  ear  or  labyrinth. 
Osseous  labyrinth. 
Vestibule. 

Semicircular  canals. 
Cochlea. 


FIG.  68. — SECTION  OF  THE  TYMPANUM,  ETC.     Enlarged. — (Morris.) 


HEAD  OF  MALLEUS 

LONG  CRUS  OF  INCUS 
BASE  OF  STAPES 
HEAD  OF  STAPES 

ORBICULAR  BONE,  OR 

LENTICULAR  PROCESS 

EUSTACHIAN  TUBE 


Fibrous  layer  of 
membrana  tympani 


CAVITY  OF  TYMPANUM 


Suspensory  ligament 
ATTIC  OF  THE  TYMPANUM 
External  ligament 
SHORT  CRUS  OF  MALLEUS 

HANDLE  OF  MALLEUS 
EXTERNAL  AUDITORY  CANAL 


60  THE  BACK 

DEMONSTRATION  XL 
BACK. 

Place  the  cadaver  in  a  prone  position.  Note  the  vertebral  spines.  Sup- 
port the  chest  with  a  block  so  as  to  make  the  muscles  tense. 

Dissection:  Make  an  incision  along  the  middle  line  of  the  back  from 
the  occiput  down.  Turn  the  skin  outward  with  care  so  as  not  to  destroy 
all  of  the  posterior  primary  divisions  of  nerves.  (Fig.  69.) 

Posterior  primary  nerves: — 
Cervical. 

Internal  branches. 

External  branches. 
First  cervical. 
Second  cervical. 

Internal  branch  or  Great  Occipital. 
Third  cervical. 

Small  occipital. 

Fourth,  fifth,  sixth,  seventh  and  eighth  cervical. 
Dorsal. 

Internal  branches. 

External  branches. 

Lumbar  branches. 

Study  superficial  and  deep  fascia  of  the  back. 
Expose  and  study  the  following: — 

Muscles : 

First  layer.     (Fig.  70.) 
Trapezius. 
Latissimus  dorsi. 

'  Second  layer.     (Fig.  71.) 

Levator  anguli  scapulas. 
Rhomboideus  minor. 
Rhomboideus  major. 

Third  layer.     (Fig.  72.) 

Serratus  posticus  superior. 
Serratus  posticus  inferior. 
Splenius  capitis  colli. 


THE  BACK 


61 


FIG.  69. — DISTRIBUTION  OF  THE  POSTERIOR  PRIMARY  DIVISIONS  OF  THE  SPINAL  NERVES. 

(Henle.)     (Morris.} 


Scmi-spinalis 


Multifldua  spinae 


LongissimuB 
dorsi 


Ilio-costalia 


Trap  ezi  ns 


Gluteus 
maiimua 


62  THE  BACK 

FIG.  70. — FIRST  LAYER  OF  MUSCLES  OF  THE  BACK. — (Morris.} 


Triceps  — '- 


Teres  minor 
Infraapinatus 

Teres  major 

Rhomboideus  major 

Pectoralis  major 


Obliquus  externus 


Glutens  medius 


Glutens  maximus 


THE  BACK 


FIG.  71. — THE  LEVATOR  ANGULI  SCAPULAE  AND  RHOMBOIDEI. — (Morris.') 


Supraspinatu 


Obliquus  internus 


Complexus 
Splenius  capitis 


Levator  anguli  scapulae 


Serratus  posticua 
superior 


Rhomboideua  minor 


Splenius  colli 
Rhomboideus  major 


THE  BACK 


FIG.   72. — THE  THIRD  AND  FOURTH  LAYERS  OF  THE  MUSCLES  OF  THE  BACK. — (Morris.) 


Spleniu; 


Sple 


Serratus  posticua 


Vertebral  aponeurcwis 


Serratus  postious 
inferior 


Obliquus  interims  — 


Origin  of  latissimus 
dorsi 


SEVENTH  CERV  CAL  VERTEBRA 


TWELFTH  THORACIC  VERTEBRA 


FIFTH  LUMBAR  VERTEBRA 


THE  BACK 


FIG.   73. — SCHEME  OF  INTERCOSTAL  ARTERY.     (Walsham.)     (Morris.) 


.          Internal  division  of  muscular  branch 
Semispinalis  dorsi  and  multifidus  spinae 


Posterior  spinal  arteries 


Rftroneural  branch 

Medullary  branch 

Preneural  branch 

> /'/.V.I  /,  ffjRD 

Anterior  spinal  artery 


Intercostal  artery 

Vena  azygos  minor 
Vena  azygns  major  _ 
THORACIC  DUCT 


External  division  of  mitscular  branch 

Ilio-costalis 


Spinal  branch 


Donal  branch 


Anterior  intercostal 


Internal  mammary  artery 


Anterior  perforating  branch  if 
"  Inti-miil  mammary  artery 


SYMPATHETIC 


Lower  branch  of 
aortic  intercostal 

Upper  or  main 
branch  of  aortic 
intercostal 


Lower  branch  of 
anterior  intercostal 

Mammary  glandular 

branch 

l'/>per  or  main 
branch  of  anterior 

intercostal 


FIG.    74. — SCHEME    OF   ANASTOMOSES   OF   THE    RIGHT   SCAPULAR  ARTERIES.      (Walsham.) 

(Morris. ) 

Snhscapular  branch  of  suprascapular  artery 
Supratpinons  branch  of  siiprascapular  artery 


Posterior  scapular  artery 


Suitraspinott*  branch 

of  posterior  scapular 

artery 
Snbscapular  branch 

of  posterior  scapular 

artery 


Branch  of  intercostal 
artery 


Branch  of  intercostal 

artery 

Continuation  of  posterior 
scapular  artery 


Siiproicapular  artery 


Acromial  branch 
ofacromio- 
thoracic 

Acromial  rete 


Subscapular  branch 

of  svprascapiilar 

artery 
Infraspinovs  branch 

of  suprascapular 

artery 
Sttbscajmlfir  branch 

of  axillary  artery 


Dorsal  scapular  branch  of 
subscapnlar  artery 


Continuation  of  sub- 
scapular  artery 


66 


THE  BACK 


FIG.  75. — THE  FIFTH  LAYER  OF  THE  MUSCLES  OF  THE  BACK. — (Morris.) 


Com  pi 


Traehelo-m 


Transversalis  colli 


Cervicalis  ascendens 


Longissimus  dorsi 


Aceessorius  ad  ilio- 

costalera 


Spinalis  dorsi 


Ilio-eostalis 


Obliquus  internus 


Erector  spinae 


SEVENTH  CERVICAL  VERTEBRA 


TWELFTH  THORACIC  VERTEBRA 


FIFTH  LUMBAR  VERTEBRA 


SUBOCCIPITAL  TRIANGLE 


67 


Arteries  (Figs.  73  and  74)  :— 
Intercostals. 
Posterior  scapular. 

Expose  and  study  the  erector  spinae  muscle.     (Fig.  75.) 
Study  the  vertebral  aponeurosis. 

The  remaining  muscles  of  the  back,  except  the  muscles  of  the  sub- 
occipital  triangle,  need  not  be  dissected  out.  The  names  of  the  muscles 
should,  however,  be  remembered. 


FIG.  76. — DRAWING  FROM  NATURE,  OF  THE  SUBOCCIPITAL  TRIANGLE. — (Holden.~) 
and  7.  Complexus.  2.  Rectus  cap.  posticus  minor.  3.  Rectus  cap.  posticus  major. 
4.  Obliquus  inferior.  5.  Sternomastoid.  6.  Semispinalis  colli.  8.  Obliquus  superior. 
10.  Splenius.  n.  Trachelo-mastoid.  12.  Great  occipital  nerve.  13.  Occipital  artery 
giving  off  its  descending  branch — the  princeps  ceruicis.  14.  Suboccipital  nerve.  15. 
Third  cervical  nerve  (posterior  branch). 


SUBOCCIPITAL  TRIANGLE. 


Muscles : — 

Rectus  capitis  posticus  major. 

Rectus  capitis  posticus  minor. 

Obliquus  capitis  inferior. 

Obliquus  capitis  superior. 
Xerves : — 

First  cervical  (suboccipitalis). 

Second  cervical. 

Great  occipital. 
Arteries : — 

Vertebral.     (See  Fig.  49.) 

Occipital. 

Princeps  cervicis. 

Deep  cervical. 


68 


PECTORAL  REGION 


DEMONSTRATION  XII. 

PECTORAL  AND  AXILLARY  REGION. 

Examine  in  the  articulated  skeleton  the  position  of  the  following 

Clavicle.     Sternum. 

Scapula  and  processes. 

Shoulder  joint. 

Ribs.     Costal  cartilages. 
Outline  position  of  the  heart.     (Fig.  85.) 

FIG.   77. — THE  PECTORALIS  MAJOR  AND  DELTOID. — (Morris.) 


Biceps 


Terse  major 


Serratus  magnus 


I Aponeurosis  of  external  oblique 


External  intercostal 


Place  the  cadaver  upon  its  back,  draw  the  arm  out  to  a  right  angle  with  the 
trunk,  then  make  a  vertical  incision  through  the  skin  in  the  median  line  from 
the  upper  to  the  lower  part  of  the  sternum;  a  second  incision  from  the  ensi- 
form  cartilage  along  the  inner  fold  of  the  axilla  to  the  deltoid  muscle;  a  third 
incision  from  the  middle  of  the  clavicle  along  the  anterior  part  of  the  upper 
third  of  the  arm.  Remove  the  skin  from  the  pectoral  region,  turn  it  outward 
from  the  upper  arm,  outward  and  backward  from  the  axilla. 

Note  and  study  the  superficial  fascia,  pectoral  fascia,  clavi-pectoral 
fascia,  costo-coracoid  membrane,  and  axillary  fascia. 


PECTORAL  REGION  AND  AXILLA  69 

Study  superficial  nerves.     (See  Fig.  81.) 
Study  mammary  gland. 

Study  the  lymphatics  of  the  thorax,  upper  extremity,  and  axilla. 
Expose  and  study  the  pectoralis  major  muscle.     (Fig.  77.) 
Detach  this  muscle  from  its  origin  and  turn  it  outward.     See  the  an- 
terior thoracic  nerves  as  they  enter  the  muscle  on  the  posterior  surface. 
Clean  and  study  the  pectoralis  minor  muscle.     (See  Fig.  78.) 
Detach  this  muscle  from  its  origin  and  turn  it  outward. 
Clean  and  study  the  subclavius  muscle.     (See  Fig.  79.) 
Clean  and  study:— 
Nerves : — 

Anterior  thoracic. 
External. 
Internal. 
Dorsal.     (Fig.  80.) 

Anterior  primary  divisions. 
Lateral. 
Anterior. 

Intercosto-humeral  (Fig.  81) — this  lateral  branch  of  the 
second  dorsal  passes  out  from  the  second  intercostal  space 
to  the  arm. 

Expose  the  brachial  plexus  and  notice  the  relation  the  cord  and  larger 
branches  bear  to  the  blood-vessels.     (Figs.  94,  98,  100.) 
Arteries  :— 

Perforating  branches  of  internal  mammary.     (Fig.  82.) 
Axillary  and  branches.     (See  Fig.  83.) 
Veins : — 

Axillary  and  tributaries. 

Expose  and  study  the  serratus  magnus  muscle  (M.  serratus  anterior). 
(Fig.  84.) 

Review  carefully  the  lymphatic  nodes  and  afferent  and  efferent  vessels 
of  the  axilla. 

When  all  the  structures  in  the  axilla  are  exposed  study  their  relative 
positions  to  each  other  and  to  surrounding  parts. 


7o 


PECTORAL  REGION 


FIG.  78. — THE  PECTORALIS  MINOR,  OBLIQUUS  INTERNUS,  PYRAMIDALIS,  AND  RECTUS  AB- 

DOMINIS. — (Morris.} 


Subscapularis 


Pectoralis  minor 


Pectoralis  major 
•77  Teres  major 


Internal  oblique 


Pyramidalis 
Conjoined  tendon 


PECTORAL  REGION 


71 


FIG.   79. — THE  SUBCLAVICS  AND  THE  UPPER  PORTION*  OF  THE  SERRATUS  MAGNUS. — (Morris.) 


Subclavius 


Serratus  magnos 


\ 


FIG.  80. — DIAGRAM  OF  THE  DISTRIBUTION  OF  A  TYPICAL  DORSAL  NERVE. — (Morris.) 


INTERNAL  BRANrif 

Longiasirnus  Dorsi 


Semispinalis  Dorsi 
Multifldua  Spinae 

Superior  Costo-transverse 

Ligament 
POSTERIOR  ROOT 

ANTERIOR  ROOT—J 
RECURRENT  BRANCH 
SYMPA  THETIC  GANGLION 

EFFERENT  BRA  NC1I 

BR ASCII  TO  AORTA 

(Esophagus 


Internal  Mammary  Artery 
Triaugularis  Sterni 


AccesBOrius 

EXTERNAL  BRANCH 

POSTERIOR  PRIMARY 
DIVISION 
ANTERIOR  PRIMARY 

Dl  VISION 
Internal  Intercostal  Muscle 

External  Intercostal  Muscle 


LATERAL  BRANCH 


ANTERIOR  BRANCH 


Anterior  Intercostal  Membrane 


72 


PECTORAL  REGION 


FIG.   81. — CUTANEOUS  NERVES  OF  THE  THORAX  AND  ABDOMEN,  VIEWED  FROM  THE  SIDE. 

(After  Henle.)     (Morris.) 


Fectoralis  major 


SUPRA  CLA  VTCULAR 
BRANCH  OF 
CERVICAL  PLEXUS 


Pectoralis  minor rr— 


INTERCOSTO- 
HUMERAL 


11   !;I**#!TJ —  Latissimus  dorsi 


Sheath  of  rectus 


ANTERIOR 

CUTANEOUS  OF 
LAST  THORACIC 


ILIO- 
HYPOGASTRIC 


ILIO-INGUINAL 


Serratus  magnus 


Ezternal  oblique 


LATERAL  CUTANEOUS 
OF  LAST  THORACIC 
NERVE 


IXTERXAL   MAMMARY  ARTERY 


73 


FIG.  82. — SCHEME  OF  THE  RIGHT  INTERNAL  MAMMARY  ARTERY. — (Walsham.)    (Morris.) 

Common  carotid  artery 


PHREXLC  XER  VE 

Sabclarian  artery 

Subclavian  i-ein,  cut 


Anterior  intercostal  branch 


Anterior  intercostal  branch 


Mutcvlo-phrenic  artery 


Deep  circumflex  iliac  artery 


Internal  jugular  vein 
Subclarian  rein,  cut 
Scalenua  anticus  muscle 

STERNUM 

Triangularis  sterni  muscle 
Perforating  branch 


Superior  epigattric  artery 


Deep  epigattric  artery 


FIG.   83. — DIAGRAM  OF  AXILLA. — (Holden.) 

i.  Axillary  artery.  2.  Brachial  artery.  3.  Thoracica  humeraria  artery.  4.  Superior 
thoracic  artery.  5.  Subscapular  artery.  6.  Dorsalis  scapulae  artery.  7.  Posterior 
circumflex  artery.  8.  Superior  profunda  artery.  9.  Posterior  thoracic  nerve.  10. 
Long  subscapular  nerve,  n.  Median  nerve.  12.  Cephalic  vein.  13.  Musculo-cuta- 
neous  nerve.  14.  Teres  major. 


FIG.  84. — SERRATUS  MAGNUS. — (Morris.} 


Upper  part  of 

eerratus  magnus 


Middle  part 


Lower  part 


74 


THORAX 


75 


DEMONSTRATION  XIII. 

THORAX  AND  THORACIC  VISCERA. 

Study  the  thorax  in  the  articulated  skeleton.     Note: — 

Cavity  of  thorax. 

Superior  aperture. 

Inferior  aperture. 

Costal  arches. 

Intercostal  spaces. 

Locate  the  position  of  heart  and  its  valves. 

Xow  cut  the  costal  cartilages  where  they  join  the  ribs  and  remove  them 
with  the  sternum.  Do  this  with  care  so  as  not  to  destroy  the  structures 
beneath. 

Xote  and  study  internal  mammary  artery  and  branches.     (See  Fig.  82.) 


FIG.  85. — SHOWING  THE  POSITION  OF  THE  HEART  AND  ITS  VALVES  IN  RELATION  TO  THE 

CHEST  WALLS. — (Morris.) 

(Reduced  from  Hensman  and  Fisher's  Anatomical  Outlines.) 

(The  right  auricle  and  ventricle,  with  the  pulmonary  semilunar  and  tricuspid  valves,  are 
outlined  in  blue  tints;  whilst  the  left  auricle  and  ventricle,  with  their  corresponding 
valves,  are  indicated  in  red.) 


76 


THORAX 


FIG.   86. — ANTERIOR  VIEW  OF  THE  THORAX  WITH  CHEST  WALL  REMOVED,  SHOWING  THE 
LUNGS.      (Modified  from  Bourgery.)      (Morris.} 


CLAVICLE 


Pectoralis  major  muscle 
Peetoralis  minor  muscla 

SUPERIOR  LOBE 


Serratus  magnua 
muacle 


MIDDLE  LOBE 


Diaphragm 

STERNUM 


ENSIFORM  CARTILAGE 


Trace  as  far  as  possible  and  study  the  pericardium. 

Trace  as  far  as  possible  and  study  the  pleura. 

Mediastinal  space.     What  is  it? 

Study  the  thymus  gland.     (See  Fig.  35.) 

Study  the  position  and  relation  of  the  heart,  large  blood-vessels,  lungs, 
trachea,  bronchi,  and  oesophagus.  (Figs.  87,  88,  92.) 

Trace  the  phrenic  nerve  down  between  the  pericardium  and  pleura. 
(Fig.  88.) 

Trace  the  vagus  nerve  down  to  the  pulmonary  plexus.     (Figs.  88  and  89.) 

Remove  the  heart  and  lungs.  Cut  the  arch  of  the  aorta  just  beyond 
the  origin  of  the  left  subclavian  artery.  Cut  the  pericardium  from  the 
diaphragm.  Lay  the  heart  and  lungs  aside  and  dissect  out  and  study  the 
following : 


Muscles  :— 

Intercostal. 
External. 
Internal. 
Diaphragm. 
Dorsal,  or  intercostal  nerves.     (See  Fig.  80.) 


Infracostalis  (Mm.  subcostales] . 
Triangularis  sterni  (M.  transversus  thoracis}. 
Levatores  costarum. 


THORACIC  VISCERA 


77 


FIG.  87. — ANTERIOR  VIKW  OF  THE  LUNGS;    PERICARDIUM.      (Modified  from  Bourgery.) 

(Morris.) 


Vena  cava  superior 


BRONCHUS 

Pulmonary  artery 
Pulmonary  vein 


Arch. of  aorta 

Pulmonary  artery 
BRONCHUS 
Pulmonary  vein 


ENSIFORM  CARTILAGE 


THORACIC  VISCERA 


FIG.  88. — THE  ARCH  OF  THE  AORTA 
OF  THE  AORTA. — 

RIGHT  RECUR- 
RENT LA  RYN- 
GEAL  NERVE 

Transverse  cervical 

artery 
Right  common  carotid 

artery 
Suprascapular  artery 

Internal  jugular  vein 

PNEUMOGASTRIC 
NERVE 
Stibclavian  vein 

Inferior  thyroid  vein 

PHRENIC  NER  VE 

Left  innominate  vein 

Ascending  aorta 

Superior  vena  cava 
RIGHT  BRONCHUS 

Branch  to  superior  lobe 

of  lung 

Upper  branch  of  right 

pulmonary  «/•//•/•// 

Branch  to  middle  lobe 

of  lung 
Right  pulmonary  vein 

RIGHT  AURICLE 

Right  coronary  artery 
Lower  branch  of  right 
pulmonary  «/•//'/•// 
THORACIC  VERTEBRA 

Intercostal  vein 
Intercostal  artery 
Vena  azygos  major 

Intercostal  vein 
Intercostal  artery 

Intercostal  vein 
Intercostal  artery 


WITH  THE  PULMONARY  ARTERY  AND  CHIEF  BRANCHES 
(Morris.).     Also  see  Fig.  96. 


THYROID  BODY 
LEFT  RECURRENT 
LARYNGEAL 
NER  VE 
1'NEIMOGASTRIC 

NER  VE 
Left  internal  jugular 

vein 
Left  common  carotid 

artery 
Left  subclavian  artery 

Left  subclavian  vein 

TRACHEA 

Inferior  thyroid  vein 

PHRENIC  NKR  VE 

(huokeil  aside) 
RECURRENT 
J.MiYNGEAL 
NERVE 

PNEUMOGASTRIC 
NERVE 

DUCTUS  ARTERIOSU8 

Lqft  pulmonary  artery 

Pulmonary  artery 

Right  pulmonary 
artery 

LEFT  BRONCHUS 

Left  coronary  artery 

f'jtpi'i-  left  pulmonary 

vein 
RIGHT  VENTRICLE 

(Conus  arteriosus) 
Ltiii-rr  left  iniliiiimtiry 

artery 
Lover  left  /mlmonary 

rein 

(ESOPHAGUS 
(hooked  aside^ 


THORACIC  DUCT 
Thoracic  aorta 


VAGUS  AXD  SYMPATHETIC  XERVES 


79 


FIG.  89. — THE  CERVICAL  PORTION-  OF  THE  SYMPATHETIC  AND  THE 
PNEUMOGASTRIC  NERVE.  VIEWED  FROM  BEHIND.  (Krause.) 
Fig.  88. 


DISTRIBUTION  OF  THE 
(Morris.')      Also    see 


Stylo-hyoid 


Ligamentum  pharyngeum 

1X1 


Posterior  belly  of 
digastric 


Sterno-mastoid 

Rectus  capitis 
anticus  major 

Stylo-pharyngei»e 

Stylo-gloss  us 

Internal  pterygoid 

SUPERIOR 
CERVICAL 
GAXGLIUS 

Middle  constrictor 

Common  carotid 
artery 

Inferior  constrictor 


THYROIHEl'M 
I  RIETY) 

THYROID  GLAND 


Inferior  thyroid 

artery 
Subclarian  arltry 


RECURRENT 

LARYXGEAI. 

A'ERl'E 


Thoracic  aorta 


Crus  of  diaphragm 


Internal  carotid 

artery 
RIGHT 
SYMPA  THETIC 

Occipital  artery 

Posterior  belly  of 
digastric 


DESCENDERS 

HYPOGLOSSI 

Common  carotid 
artery 

Sterno-mastoid 

TWIG  OF 
RECl'RREXT 
LARYSGEAL  TO 
PHARYSGEAL 
PLEXUS 


Thyroid  axis 

INFERIOR 
CERVICAL 
GAXGLIOS 


RECCRREXT 
LARYXGEAL 


PLEXUS  Gl'LJE 


RIGHT 
PSEUMOGASTRIC 


8o 


THE  HEART 


FIG.   90. — ANTERIOR  VIEW  OF  THE    RIGHT   CHAMBERS  OF  THE    HEART,  WITH  THE  GREAT 

VESSELS. — (Morris.) 


Left  subclavian 


Arch  of  Aorta 
Vena  cava  superior 


RIGHT  AURICULAR 

APPENDIX  \^ 

Orifice  of  vein  j 

of  Galen  \l 


ANNULUS  OVALIS 


Right  pulmonary  artery 
Duclus  arteriosus 

Left  pulmonary  artery 

\onary  artery 

onary  semilunar  valves 


AURICULAR  APPENDIX 


papillary  muscle  connected 
vmh  septum 


(1)  Columna  carnea 
/  CHORD*  TENDINE/E 


Anterior  papillary 
muscle 


Left  coronary  artery 


Vena  cava  inferior 
ANTERIOR  SEGMENT  OF  TRICUSPID  VALVE 


RIGHT  SEGMENT  OF  TRICUSPIO  VALVE 

SECTION  OF  VENTRICULAR  WALL 


Vena  cava  inferior 


Posterior  papil-    (2)  Columna  carnea 
lary  muscle 


HEART  AXD  LUXGS  81 

HEART. 

Study  the  heart : — 
Position. 
Size  and  weight. 
Auriculo-ventricular  groove. 
Interventricular  groove  or  coronary  sulcus. 
Coronary  arteries. 

Dissect  the  heart.     Make  an  incision  as  shown  in  figure  90. 
Also  make  a  dissection  of  the  heart  of  an  ox  or  sheep. 
Examine  and  study  carefully  the  whole  of  the  exterior  and  interior  of 
the  heart. 

What  is  its  nerve-  and  blood-supply? 
Study  the  foetal  heart  and  foetal  circulation.     (Fig.  91.) 
Expose  and  study  pulmonary  arteries  and  pulmonary  veins.     (See  Figs. 
87  and  88.) 

Expose  and  study:— 

Aorta  (See  Figs.  90,  92):— 
Branches  of  arch: — 
Coronary. 
Innominate. 
Left  common  carotid. 
Left  subclavian. 
Thyroidea  ima. 

Branches  of  descending  aorta  in  thorax. 
Pericardiac.  Intercostal. 

Bronchial.  Diaphragmatic. 

(Esophageal. 

Superior  intercostal  artery.     (See  Fig.  93.) 
Veins  (See  Fig.  88)  :— 

Innominate  right.  Superior  vena  cava. 

Innominate  left.  Azygos and  tributaries.     (Fig.  92.) 

Internal  mammary.  Spinal  veins.     (Fig.  94.) 

Superior  intercostal. 

Expose  and  study  thoracic  duct.     (See  Fig.  92.) 
Clean  and  study  the  thoracic  gangliated  cord. 

LUNGS. 

Xote  the  position  in  the  thorax, — upper  and  lower  boundaries.  (See 
Figs.  86  and  87.) 

Describe  the  lungs. 

What  is  the  blood-  and  nerve-supply?' 

Study  the  trachea  and  bronchi.     (Fig.  87.) 

Xote  the  relation  of  oesophagus  to  the  trachea.     Study  oesophagus. 

Study  the  articulations  of  the  ribs  with  the  vertebrae,  and  the  cartilages 
with  the  ribs  and  sternum. 


82 


FCETAL  CIRCULATION 


FIG.  91. — THE  HEART,  WITH  THE   ARCH  OF  THE   AORTA,  THE    PULMONARY  ARTERY,  THE 
DUCTUS  ARTERIOSUS,  AND  THE  VESSELS  CONCERNED  IN  THE  FCETAL  CIRCULATION. — 
(Morris.} 
(From  a  preparation  of  a  fetus  in  the  Museum  of  St.  Bartholomew's  Hospital.) 


Right  innominate  vein 

Vena  cava  superior 
Right  pulmonary  artery 


Vena  cava  inferior 


Left  branch  of  portal  vein 
DUCTUS  VENOSUS 


Umbilical  vein 

Portal  vein 

Right  branch  of 
portal  vein 


Umbilical  vein 
Umbilical  arteries 

Jfypogastric  artery 


Left  innominate 
rein 


Arch  of  aorta 

DUCTUS  ARTERIOSUS 

Left  pulmonary 
artery 


Descending  aorta 


» Superior 

mesenteric  artery 


Splenic  vein 

Superior 
mesenteric  vein 


Inferior 

mesenteric  artery 


_jj|j. Left  common  iliac 

~^';(>  artery 


Internal  iliac  arii'nj 

External  iliac  artfrij 


AORTA,  VEINS,  AND  THORACIC  DUCT 


FIG.  92. — THE  ARCH  OF  THE  AORTA,  THE  THORACIC  AORTA,  AND  THE  ABDOMINAL  AORTA, 
WITH  THE  SUPERIOR  AND  INFERIOR  VENA  CAVA  AND  THE  INNOMINATE  AND  AZYGOS 
VEINS. — (Morris.) 


Right  common  carotid 

artery 
Right  internal  jugular 


RIGHT  LYMPHATIC  DUCT 

Innominate  artery 

RIGHT  PJTXUMO- 

GASTRIC  SERVE 

Right  innominate  rf.in 

Internal  mammary  vein 

Trunk  of  the  pericardiac 
and  thyniic  reins 
Vena  cata  superior 


Vena  azygos  major 


Vena  azygos  minor,  cross- 
ing spine  to  enter  rena 
azygot  major 

Hepatic  reim 


Vena  cava  inferior 

Right  phrenic  artery 
Caeliac  axis 

Right  middle  suprarenal 
artery 


Right  spermatic  artery 
Right  spermatic  vein 


Left  common  carotid 
artery 


TRIC  SER  VE 
THORACIC  DUCT 
Left  innominate  vein 
Left  subclai'ian  artery 


Left  superior  intercostal 

rein 

RECURRENT 
LARYSGEAL 
SERVE 


Vena  azygos  tertius 

ESOPHAGUS 

Left  upper  azygos  rein 

(Etophageal  branches 
from  aorta 

Vena  azygos  minor 


THORACIC  DUCT 


Left  phrenic  artery 

Left  middle  suprarenal 
artery 

RECEPTACULUM  CHYLI 

Superior  mesenteric 
artery 

Left  ascending  lumbar  • 

rein 
Left  spermatic  vessels 


Inferior  mesenteric 
artery 


84 


ARTERIES  AND   VEINS 


FIG.  93. — SCHEME    OF   THE   RIGHT   SUPERIOR    INTERCOSTAL   ARTERY.     (Walsham.) 

(Morris.} 


Scalenus  anticus  muscle 

Deep  cervical  branch 

FIRST  DORSAL  NERVE 


FIRST  INTERCOSTAL 
NERVE 

Subclavian  artery 


SECOND  INTERCOSTAL 
NER  VE 


Anterior  intercostal 

artery 

THIRD  INTER- 
COSTAL NERVE 


Anterior  intercostal 
artery 

Internal  mammary 
artery 

Intercostal  vessels  of 
third  space 


SYMPA  THETIC 
NER  VE 


INFERIOR  CERVI- 
CAL GANGLION 

\  Superior  intercostal 
)  artery 


Arteria  qperrans 


Branch  from  first  aortic 
intercostal 


Arteria  aberrant 


First  aortic  intercostal 
artery 


Second  aortic  intercostal 
artery 


Intercostal  vessels  of  fourth  space 


FIG.  94. — THE  SPINAL  VEINS. — (Morris.} 


ACCESSORY    PRO- 
CESS     OR     TIP 
OF    THE    TRUE 
TRANSVERSE 
PROCESS 

COSTAL  ELEMENT 

Posterior  transverse 

branch 


Vein  from  cord 
Transverse  branc 

A  nlerwr  transfers 
vein 

Lumbar  vein 


Dorsal  spinal  plexus 


I'll.ltfl-ilir     IdllljillKlilKll 
l  r,  in 

Lateral  transverse 

branch 

Anterior  /onr/i/in/ii/ril 
spinal  vein  seen  in 
fiction 

Veins  from  body  of 
vtriebra 


Anterior  spinal  plexus 


SHOULDER  AND  ARM  85 

DEMONSTRATION  XIV. 

SHOULDER  AND  ARM. 

Sever  the  spinal  column  above  and  below  the  brachial  plexus;    then  saw 
the  piece  thus  severed  through  the  middle,  lengthwise. 


FIG.  95. — THE  BRACHIAL  ARTERY,  LEFT  SIDE. — (Morris.) 
(From  a  dissection  in  the  Museum  of  the  Royal  College  of  Surgeons  ) 


Supratcajmlar  artery  and  nerve 


Subscapular  vessels 


CIRCUMFLEX 
XER  VE 


SUBSCAPULAR ^ 

SER  VE 


Axillary  artery  and 

vein 

MUSCULO-CUTA- 
XEOUS  and  in- 
ternally outer 
—       head  of  MEDIAN 

X£R  VE 

~   One  of  the  brachial 
veins 


Coraeo-brachialis 


Triceps 


ULNAR  NERVE 

Triceps 

Inferior  profunda  artery 


IXTERXA  L  CUTA  XEO  US 
NEBVB 

Brachial  artery 

MEDIAN  NEE  VE 


Ulnar  artery 


Biceps 


Cephalic  vein 
Anastomotica  magna  artery 


MUSCUL  O-CUTA  NEO  US 
NER  VE 


Supinator  longua 
Radial  rein 


Median  vein 


Radial  artery 


86 


SHOULDER  AND  ARM 


FIG.  96. — SUPERFICIAL  VEINS  AND  LYMPHATICS  OF  THE  LEFT  FOREARM  AND  ARM. 

(Walsham.)     (Morris.) 


Fectoralis  major,  hooked  up 


External  jvgular  vein 


Pectoralis  major 


Lymphatics  from  side  of  chest 


Pectoral  glands 


Basilic  vein 


Epitrochlear  gland       ,^_  _^___^ 
ial  ulnar    '"/   ~^-. 


Posterior  superficia 

vein  • 
Median  basilic  vein 
Inner  set  of  superficial  lym- 
phatics of  forearm 

Deep  median  vein 

INTERNAL  CUTANEOUS 
NERVE 

Anterior  superficial  ulnar 
vein 


Median  set  of  superficial  lym-  . 
phatics  of  forearm 


Supraclariciilar  gland 
Jugulo-cephalic  vein 

Deltoid  muscle 

LymphaHet  lu-i-uinjianying 

vephulir  ri  in 

-  Axillary  glaiula 
Cephalic  vein 


Lymphatic  i-exxfls  of  inner 
side  of  arm 


Biceps,  exposed 

MUSCULO-CUTANEOUS 
NER  VE 

lilitl  artery 
Bicipital  fascia 
Median  cephalic  vein 

Superficial  radial  vein 
Superficial  median  rein 


Outer  set  of  superficial  lym- 
phatic vessels  of  forearm 


SHOULDER  AND  ARM  87 

Study  on  the  skeleton  the  bones  of  the  shoulder-  and  elbow-joints. 

Outline  arteries,  superficial  veins,  and  superficial  nerves.  (See  Figs. 
95,  96,  and  97.) 

Dissection. — -Make  an  incision  down  the  anterior  part  of  the  arm  to 
inches  below  the  elbow;  turn  the  skin  outward  and  inward,  exposing  the 
superficial  fascia,  veins,  and  nerves. 

Study  the  superficial  and  deep  fascia  and  lymphatics.  Xote  the  epi- 
trochlear  gland.  (Fig.  96.) 


FIG.  97. — DISTRIBUTION  OF  CUTANEOUS  NERVES  ON  THE  ANTERIOR  AND  POSTERIOR  ASPECTS 
OF  THE  SUPERIOR  EXTREMITY. — (Morris.) 


IXTERXAL 
CUTAXEOCS  OP 

Ml'?' 

SPIRAL 


IXTER.VA  L 
Cl'TAXEUl'S 


PALMAR 

'TTAXEOrS  OF 
MSDIAA' 

PALMAR 

fTTAXEOl'ii  OF 
L'LXAB 


SUPRA- 
ACBOMIAL 


CIRCUMFLEX 

IXTERCOSTO- 
HUMERAL 

TWIG  OP 

IXTERXAL 
CUTAXEOCS 

EXTERXAL 
CUTAXEOl'S  OP 

MCSCCLO- 

SPIRAL 


MT'SCULO- 
CUTASEOUS 


PALMAR 
<  I'TAXEOUS 
OF  RADIAL 


SUPRA- 
ACROMIAL 


EXTERXAL 

CUTAXEOVS 

OF 

JtrsccLO- 
SPIRAL 


xrscrLO- 

CCTAXSOCS 


IXTERXAL 
CUTANEOUS  OP 

MCSCULO- 

SPIRAL 
IXTERCOSTO- 

BUJfERAL 


XERVE  OF 
WRISBERG 


IXTERNAL 
CUTANEOUS 


RADIAL 


ULXAR 


Clean  and  study  the  following:— 
Veins  (see  Fig.  96):— 
Cephalic. 

Median  cephalic. 
Basilic.     (See  Fig.  95.) 
Median  basilic. 


88 


SHOULDER  AND  ARM 


Bicipital  fascia.     (See  Fig.  98.) 

Note  the  relative  positions  of  the  veins,  arteries,  and  nerves  in  front 
of  the  elbow. 

Review  the  subclavian  and  axillary  arteries.     Then  trace  out  the:— 
Brachial  artery  and  its  branches.     (Fig.  99.) 
Brachial  veins  and  tributaries. 


FIG.   98. — THE  BEND  OF  THE  ELBOW,  LEFT  SIDE. — (Morris.) 
(From  a  dissection  by  Dr.  Alder  Smith  in  the  Museum  of  St.  Bartholomew's  Hospital.) 


MEDIAN  NERVE 
Posterior  branch  of 
anastomotica  magna 
BRANCHES  OF 
INTERNAL  CUTA- 
NEOUS NERVE 

Posterior  ulnar  vein 


Brachialis  antieus 

Anterior  branch  of 
anastomolica  magna  ' 
Anterior  ulnar  veil. 


Median  basilic  vein 

MUSCULAR  BRANCH 
OF  MEDIAN  NERVE 

Tendon  of  biceps 
Bicipital  fascia 

Brachialis  antieus 

Deep  median  vein 

Ulnar  artery 

Pronator  teres 


Radial  artery 


Biceps 
Internal  vena 

C/l/tll'X  I  if 

liriK'liiul  nr/ery 
Basilic  n'in 

Brachialis 
antieus 


Brachial  artery 
EXTERNAL 

ffTANEOrS 
NERVE 

Mvseiilo-ffiiral 
n.  and  afi-i'mliinj 
branch  of  nidinl 
recurrent  urt'Tit 
I'udial  vein 
Median  cephalic 

rein 

Asi-finling  br.  of 
radial  recurrent 
RADIAL 


JRiiilial  recurrent 

artery 

Supinator 
longus 
DetceiuUng  br. 

of  radial 
recurrent 
Median  vein 


RADIAL 
NERVE 


SHOULDER  AND  ARM 


FIG.  99. — THE  LOWER   PART  OF  THE   AXILLARY,  THE  BRACHIAL,  AND  THE   RADIAL   AND 

ULNAR  ARTERIES,   RIGHT  SIDE. — (Morris.) 
(From  a  dissection  in  the  Museum  of  the  Royal  College  of  Surgeons  of  England.) 


BRACHIAL  PLEXUS 


HEAD  OF  HUMERUS 
Pectoralis  minor,  turned  back 

ML'SCUL  0-CUTA  SEO  US  NER  VE 

BRANCH   OF   Mrt'TLO-CUTA- 

NEOUS  TO    MEIUAS   SERVE 

Coraco-brachialis 


Brachial  artery 

Superior  prof  undo  artery 
Biceps 


MUSCULO-CUTANEOUS  NERVE 

BRA ycit  OF  MUSCULO-CUTA- 
NEOUS NERVE  TO  BRACHI- 
ALIS  ANTICUS 

Brachialia  anticus 
MEDIA S  SERVE 

Inner  brachial  vena  comes 
MUSCULO-SPIRAL  NERVE 

Radial  recurrent  artery 
Supinator  longus 

Superficial  median  rein,  cut  short 


Pronator  radii  teres,  superficial 
bead,  cut 


RADIAL  NERVE  . 


Rudial  artery 

ixor  sublitnia 
rum 

MEDI  AS  SERVE 


Cut  edge  of  flexor  sublimis 
digitorum 


Flexor  longus  pollicis 


Subscapularls 
Acromio-lftoracic  artery 
Axillary  artery 
MEDI  AS  NERVE 
Subscapular  artery 

Teres  major 

Latissimus  dorsi 

Long  head  of  triceps 
MUSCULO-SPIRAL  SERVE 


•)  MUSCULAR  BRANCH  OF 
}•    MUSCULO-SPIRAL 
]      SERVE 


Inferior  prof  undo  artery 

Inner  bead  of  triceps 
ULNAR  NERVE 

Anastomolica  magna  artery 
Internal  intermuscular  septum 


MUSCULAR  BRANCHES  OF 
MEDI  AS  SERVE 

Pronator  teres  and  superficial 
flexor  muscles,  turned  back 

Anterior  ulnar  recurrent  artery 

Deep  bead  of  pronator  radii 
teres 


Posterior  ulnar  recurrent  artery 


Superficial  flexor  muscles, 
turned  back 


Anterior  interosseous  artery  and  nerve 
Flexor  profundus  digitorum 
ULNAR  NERVE 

Ulnar  artery 


Interosseous  membrane  with  cut  edge 
of  pronator  quadratus 


go  SHOULDER  AND  ARM 

Clean  and  study  the  formation  of  the: — 

BRACHIAL  PLEXUS. 

Branches  of  the  brachial  plexus:— 
Nerve  to  rhomboid. 
Suprascapular. 
Posterior  thoracic. 
Anterior  thoracic. 

Wrisberg  (n.  cutaneus  brachii  medialis  minor}. 
Internal  cutaneous  (n.  cutaneus  brachii  medialis}. 
Subscapularis. 
Musculo-cutaneus . 
Ulnar. 
Median. 

Circumflex  (n.  axillaris}. 
Musoulo-spiral  (radialis} . 


FIG.  ioo. — DIAGRAM  OF  THE  BRACHIAL  PLEXUS. — (Morris.) 
The  posterior  cord  of  the  plexus  is  darkly  shaded. 


FIFTH 
CERVICAL 


SIXTH 
CERVICAL 


SEVENTH 

CERVICAL 
TO  SCALENI  & 
LONG  US  COL  LI 
EIGHTH 
CERVICAL 
POSTERIOR 
THORACIC 

FIRST 
THORACIC 
FIRST 

INTERCOSTAL 
SECOND 
THORA  CIC 
SECOND 
INTERCOSTAL 

THIRD 
THORACIC 
THIRD 
INTERCOSTAL 


FROM  FOURTH  CERVICAL 

RHOMBOID  NERVE 
TO  PHRENIC 

•NERVE  TO  SUBCLAVIUS 

SUPRASCAPULAR 


EXTERNAL  ANTERIOR  THORACIC 


OUTER  CORD  OF  PLEXUS 
CIRCUMFLEX 
MUSCULO-CUTANEO  US 


MUSCULO-SPIRA  L 
INNER  CORD  OF  PLEXUS 

LONG 
SUBSCAPULAR 

MEDIAN 


ULNAR 
INTERNAL 
CUTANEOUS 

NERVE  OF 
WRISBERG 


INTERCOSTO-HUMERAL        LATERAL  CUTANEOUS 


Dissect  out  and  study  the  following: — 
Muscle : — 

Deltoid. 

Separate  the  deltoid  from  its  origin  and  turn  it  down. 
Note  the  posterior  circumflex  artery  and  circumflex 
nerve.     (Fig.  102.) 


SHOULDER  AXD  ARM 


91 


FIG.  10 1. — DISSECTION  OF  THE  LEFT  ARM  FROM  THE  FRONT,  SHOWING  PORTIONS  OF  THE 
ULNAR.  MEDIAN,  MUSCULO-CUTANEOUS,  AND  MVSCULO-SPIRAL  NERVES. — (Morris.) 
Also  see  Fig.  in. 


Subscapularis 


Teres  major 

Long  head  of  triceps 
Latissimus  dorsi 

MUSCULO-CUTASEOUS  SERVE 
MEDIAS  SERVE 


ULSAR  SERVE 


Internal  bead  of  triceps 


Pronator  radii  teres 
Flexor  carpi  radialis 


Pronator  radii  teres 
deep  head; 


Flexor  sublimis  digitorum 


Deltoid 


Coraco-brachialis 
Biceps 

Pectoralis  major 


Brachialis  anticus 


Biceps 


MUSCULO-SPIRAL 
SERVE 


RADIAL  NERVE 
POSTERIOR  ISTER- 

OSSEOl'S  SERVE 
Extensor  carpi  radialis 

longior 

ANTERIOR  ISTER- 
OSSEOUS  SERVE 


RADIUS 


SHOULDER  AND  ARM 


FIG.  102. — THE  RIGHT  POSTERIOR  CIRCUMFLEX  ARTERY. — (Morris.) 
(From  a  dissection  by  Mr.  Homer  in  the  Museum  of  St.  Bartholomew's  Hospital.) 


Suprascapular  artery 

SPINE  OF  SCAPULA 


Infra-spinatus,  cut 
ACROMIAL  PROCESS         I  Tere8  minor 

Superior  profunda  artery 

Posterior  circumflex  artery 
Deltoid,  reflected 


Infra-spinatus,  cut 

Teres  major 
Dorsal  scapular  artery 

Branch  of  dorsal  scapular  artery 

NER  VE  TO  TERES  MINOR 


MU8CULO-8PIRAL  NERVE 
Outer  head  of  triceps 

^  EXTERNAL  CUTANEOUS 
fcv  BRANCH  OF 

MUSCULO- 
SPIRAL  NERVE 


Long  head  of  triceps 

CUTANEOUS  BRANCH  OF  CIRCUMFLEX  NERVE,  CUT 


Muscles,  continued: — 

Supra-spinatus.     (See  Fig.  103.) 

Teres  minor. 

Teres  major. 

Subscapularis.     (See  Fig.  104.) 

Coraco-brachialis . 

Biceps  (m.  biceps  brachii}.     (See  Fig.  105.) 

Brachialis  anticus  (m.  brachialis). 

Triceps  (m.  triceps  brachii}.     (See  Fig.  103.) 

Latissimus  dorsi. 

Subanconeus  (m.  anconceus}. 

When  the  dissection  of  the  shoulder  and  arm  is  completed  place  the  parts 
in  their  proper  position  and  study  the  relation  each  part  bears  to  its  surround- 
ings. 


SHOULDER  AXD  ARM  93 

FIG.  103. — BACK  VIEW  OF  THE  SCAPULAR  MUSCLES  AND  TRICEPS. — (Morris.} 


Supra-spinatus 


Infra-spinatus 
Teres  minor 


Teres  major 


Long  head  oi  triceps 


Outer  head  of  triceps 


Inner  head  of  tricep 


FIG.  104. — FRONT  VIEW  OF  THE  SCAPULAR  MUSCLES. — (Morris.) 


CLAVICLE 
CORACOID  PROCESS 

Supra-spinatus 


Subscapulans  — 


Teres  major 
-Latissimus  dorsi 


Coraco-brachialis  and  short 
head  of  biceps 

Fectoralis  major 


94 


SHOULDER  AND  ARM 


FIG.  105. — SUPERFICIAL  VIEW  OF  THE  FRONT  OF  THE  UPPER  ARM. — (Morris.} 


Peetoralis  minor 


Coraco-brachialis 


Lone  head  of  triceps 


Inner  head  of  triceps 


Brachialia  anticus 


Semilunar  fascia  — 


Tendons  of  insertion  of  pec- 
toralis  major  and  deltoid 


Outer  head  of  triceps 


Brachialis  anticus 


Extensor  carpi  radialis 
longior 


Brachio-radialia 


FOREARM  AXD  HAND 


95 


DEMONSTRATION  XV. 

FOREARM,  WRIST,  AND  HAND. 

Study  the  bony  parts  of  the  elbow,  wrist,  and  fingers  on  the  articulated 
skeleton. 

Outline  the  superficial  nerves  and  veins. 
Study  lymphatics.     (See  Figs.  96  and  97.) 


FIG.  106. — THE  SUPERFICIAL  MUSCLES  OF  THE  PALM  OF  THE  HAND. —  (Morris.') 


Flexor  carpi  radialis 


or  ossis  metacarpi  pollicis 


Opponens  pollicia 


Abductor  pollicis 


Flexor  brevis  pollicis 


Adductor  pollicia 


First  lum- 

briealis 

—  First  dorsal 
interoe- 

seous 


lentum  vaginale 
Flexor  sublimis  digitorum 


Flexor  profundus  digitoruc 


Flexor  profundus 

digitorum 


96  FOREARM  AND  HAND 

Dissection. — Make  a  vertical  incision  along  the  anterior  middle  line 
through  the  skin  from  the  elbow  to  the  wrist,  then  make  a  transverse  in- 
cision from  the  lower  extremity  of  the  first  incision.  Turn  off  the  skin, 
exposing  the  superficial  fascia,  superficial  veins,  and  nerves. 


FIG.  107. — TENDONS  UPON  THE  DORSUM  OF  THE  HAND. — (Morris.} 


Extensor  ossis  metacarpi 
pollicis 


Extensor  brevis  pollicis 


Posterior  annular  ligament 


Attachment  of  extensor 
communis  digitorum 
to  second  phalanx 


Attachment  of  extensor 
communis  digitorum 
to  third  phalanx 


Extensor  carpi  ulnaria 


Extensor  communis  digitorum 


Extensor  minimi  digiti 


Extensor  indicia 


Dissect  the  skin  down  over  the  hand  and  fingers,  taking  care  not  to 
destroy  the  annular  ligaments  nor  the  nerves  and  arteries. 


THE  FOREARM 


97 


Observe  and  study: — 

Fascia  of  forearm. 
Fascia  of  hand.  • 
Annular  ligament  (liganientum  carpi  transversum  dorsale).  (See 

Figs.  106  and  107.) 
Palmaris  brevis  muscle.     (Fig.  106.) 
Synovial  membranes  beneath  the  anterior  annular  ligament. 


FOREARM. 

To  separate  the  muscles  of  the  forearm  begin  with  their  tendons  at 
the  wrist  and  separate  up  toward  the  origin  of  the  muscle.  In  separating 
the  muscles  do  not  destrov  the  arteries  and  nerves. 


FIG.   108. — SUPERFICIAL  MUSCLES  ox  THE  ANTERIOR  SURFACE  OF  THE  LEFT  FOREARM. — 

(Holden.) 


Inferior  part  of  the  biceps. 

Aponeurosis  of  the  biceps. 

Tendon  by  which  it  is  at-     7 
tached    to    the  biripital 
tuberosity  of  the  radius.       8 

4.    Brachialis  anticus. 

Internal    head  of    the  tri-   ., 


ceps. 

Pronator  radii  teres. 
Flexor  carpi  radialis. 
Palmaris  longus. 
Inferior   extremity   of    this 

muscle  expanding  into  the 

palmar  fascia. 
Flexor  carpi  ulnaris. 
The  attachment  to  the  pisi- 
form bone. 
Supinator    Ipngus    or   bra 

chio-radialis. 
Inferior  attachment  of  this 

muscle. 
14.    Extensor  carpi  radialis 

longior.    , 
Extensor     •  carpi      radialis 

brevior. 
Extensor    ossis    metacarpi 

poll!  tis. 


17.  Tendon    of   the    same   in- 

serted into  the  metacar- 
pal  bone. 

18.  Tendon    of    the     extensor 

secundi  intemodii  pollicis. 

19,  19.    FJexor  sublimis  digit  o- 

ggB. 

20,  20.   Tendons    of    insertion 

dividing  to  allow  the  ten- 
dons of  the  flexor  profun- 
dus  digitorum  to  pass  to 
their  insertion. 

21,  21.   Insertion  of  the  flexor 

sublimis  digitorum  to  the 
lower  part  of  the  middle 
phalanges. 

22,  22.    Attachment      of      the 

flexor  profundus  digito- 
rum to  the  distal  pha- 
langes. 

23,  23.   Lumbricales. 

24.  Abductor  pollicis. 

25.  Its  attachment  to  the  proxi- 

mal phalanx  of  the  thumb. 

26,  26.    Flexor  longus  pollicis. 

27.  Flexor  brevis  digitorum. 

28.  Abductor  minimi  digiti. 


THE  FOREARM 

Muscles  in  front  of  forearm: — 

Superficial  group.     (See  Fig.  108.) 
Palmaris  longus. 
Flexor  carpi  radialis. 
Flexor  carpi  ulnaris. 
Flexor  sublimis  digitorum. 
Pronator  radii  teres  (m.  pronator  teres}. 


FIG.  109. — FLEXOR  MUSCLES  OF  THE  FINGERS. — (Holden.) 

-;, 


1.  Flexor    sublimis    digito- 

rum. 

2.  Its  origin  from  the  inter- 

nal condyle. 

3.  Its      origin      from      the 

coronoid  process. 

4.  4.    Its    origin    from    the 

radius . 

5.  5.  Its  two  superficial  ten- 

dons to  the  middle  and 
ring  fingers. 

6.  6.    Its  two  deep  tendons 

to  the  index  and  little 
fingers. 

7.  Flexor  longus  pollicis. 

8.  Tendon  of  this  muscle. 

9.  Bifurcation  of  the  tendons 

of  the  flexor  longus 
digitorum. 

10,  10.  Groove  made  by 
these  tendons. 

n,  ii.  Tendons  of  the 
flexor  profundus  digi- 
torum occupying  these 
grooves  and  filling 
them  up. 


12.  Brachialis     anticus    ten- 

don. 

13.  Internal  condyle  of  the 

humerus. 

14.  Biceps  tendon. 

15.  Supinator      longus       or 

brachio-radialis. 

16.  Its    attachment    to    the 

styloid  process  of    the 
radius. 

17.  Extensor    carpi    radialis 

longior. 

18.  Tendon    of   insertion    of 

the  pronator  radii  teres. 

19.  Tendon    of    insertion    of 

the  flexor  carpi  radialis. 

20.  Triceps. 

21.  Flexor  carpi  ulnaris. 

22.  Its     attachment    to     the 

pisiform  bone. 

23.  Abductor  minimi  digiti. 

24.  Flexor     brevis      minimi 

digiti. 

25.  Abductor  pollicis. 


Deep  group.     (See  Fig.  109.) 
Flexor  profundus  digitorum. 
Flexor  longus  pollicis. 
Pronator  quadratus. 


THE  FOREARM 


99 


Muscles  of  the  back  of  forearm.     (See  Fig.  no.) 
Superficial  group. 
Brachio-radialis . 
Extensor  carpi  radialis  longior. 
Extensor  carpi  radialis  brevior. 
Extensor  communis  digitorum. 
Extensor  minimi  digiti. 
Extensor  carpi  ulnaris. 
Anconeus. 


FIG.   no. — SUPERFICIAL  EXTENSORS  OF  THE  FOREARM. — (Holden.) 

-  f 


1 .  Tendon  of  the  triceps. 

2.  Origin  of  the  supinator 
longus   or   brachio-radi- 
alis. 

3.  Extensor  carpi  radialis 
longior. 

4.  Insertion  of  this  muscle. 

5.  Extensor    radialis  bre- 
vior. 

6.  Insertion  of  this  muscle. 

7.  Extensor    ossis     meta- 
carpi  pollicis. 

8.  8.    Extensor   brevis  or 
primi  intemodii  pollicis. 

9.  9.    Extensor  longus  or 
secundi    internodii   pol- 
licis. 

10,  10.    Posterior    annular 
ligament. 

11,  Extensor  communis  di- 
gitorura. 

12,  12.  Attachments  of  the 


tendons  of  this  muscle 
to  the  middle  and  distal 
phalanges  of  the  four 
fingers. 

13.  Tendons,  of  the   exten- 
sor indicis  uniting  with 
the  tendon  of  the  com- 
munis digitorum  indicis. 

14.  Tendon    of  the   exten- 
sor minimi    digiti    min- 
gling   posteriorly    with 
the  tendon  of  the  com- 
munis to  the  little  finger. 

15.  Extensor      carpi      ul- 
naris. 

16.  Its    insertion    into  the 
metacarpal  bone. 

17.  Anconeus. 

18.  Flexor     carpi    ulnaris 
attached  to  the  posterior 
border  of  the  ulna    by 
the  aponeurosis. 


Deep  group. 

Supinator  radii  brevis  (m.  supinator). 

Extensor  ossis  metacarpi  pollicis  (m.  abductor  pollicis  longus}. 

Extensor  brevis  pollicis. 


ioo  THE  FOREARM 

Extensor  longus  pollicis. 

Extensor  indicis. 

Trace  out  and  study  the  arteries  and  nerves  of  the  forearm. 
Nerves.     (See  Figs,  in  and  112): — 
Internal  cutaneous. 
Median. 

Anterior  interosseous. 
Ulnar. 
Musculo-spiral  (radialis] . 

Radial. 

Posterior  interosseous. 


FIG.  in. — TERMINAL  PORTION  OF  THE  MEDIAN  AND  ULNAR  NERVES. — (Holden.) 
Forearm,  palmar,  and  digital  portions  of  these  nerves.  13.  Branch  to  the  pronator 
radii  teres  muscle.  14.  Anterior  muscular  branches  divided  and  removed.  15. 
Branch  to  the  flexor  profundus  digitorum.  16.  Branch  to  the  flexor  longus  pol- 
licis. 17.  Branch  to  the  interosseous  membrane.  18.  Palmar  (cutaneous)  branch 
divided  below  its  origin.  19.  To  the  thenar  eminence.  20.  External  lateral  branch 
of  the  thumb.  21.  Internal  lateral  branch  of  the  same.  22.  External  digital  branch 
to  the  index  ringer.  23.  Common  trunk  to  the  index  and  middle  fingers.  24.  Digi- 
tal branches  from  the  median  to  the  middle  finger  and  the  thumb  side  of  the  ring 
finger.  25.  Ulnar  nerve.  26.  Branch  of  the  same  nerve  to  the  flexor  profundus 
digitorum.  27.  Cutaneous  and  anastomosing  filament  from  the  ulnar.  28.  Dorsal 
branch  of  this  nerve.  29.  Superficial  palmar  branch.  30.  Common  trunk  for  the 
ring  and  little  fingers.  31.  Digital  branch  to  the  internal  side  of  the  little  finger.  32. 
Deep  palmar  branch.  33.  Branches  from  the  preceding  to  the  hypothenar  eminence. 
34.  Branches  to  the  fourth  interosseous  and  fourth  lumbricales.  35.  Branches  to  the 
same  in  the  third.  36.  Branches  to  the  adductor  pollicis  and  the  muscles  of  the  first 
and  second  interosseous  spaces.  37,  38,  39,  40.  Branches  of  radial. 


16 ' 


12 


THE  FOREARM 

Arteries  (Figs,  in,  113,  and  114):— 
Radial  and  branches. 
Ulnar  and  branches. 
Anastomosis  about  elbow-joint. 

FIG.  112. — TERMINAL  BRANCHES  OF  THE  RADIAL  XERVE. — (Holden.) 


101 


1 .  Trunk  of  the  radial  nerve. 

2.  Its      branch     to     brachio- 

radialis. 

3.  Its  branch  to  extensor  car- 

pi radialis  longior. 

4.  Its  branch  to  extensor  car- 

pi radialis  brevior. 

5.  Bifurcation  of  the  trunk. 

6.  Posterior    or    muscular 

branch. 

7.  The  same  branch  travers- 

ing the   supinator  brevis 
and  supplying  it. 


8.  Terminal  filaments  of  this 

division. 

9,  9.   Anterior    or    cutaneous 

branch  of  this  nerve. 

10.  Termination   of  this 

branch. 

11.  Musculo-cutaneous  n. 

12.  Its  terminal  divisions. 

13.  Anastomosing  branch  with 

the  cutaneous  division  of 
the  radial 


IO2 


THE  FOREARM 


THE  ARTERIES  OF  THE  FOREARM  WITH  THE  SUPERFICIAL  PALMAR  ARCH. 

(Morris.} 


Biceps 


Brachialis  anticus 

Tendon  of  biceps 

Semilunar  fascia  of  biceps 

Radial  recurrent  artery 

Supinator  longus 

RADIAL  NERVE 

Radial  artery 


Flexor  longus  pollicis 


Pronator  quadratus 

Radial  artery  winding  to  back  of 
wrist  under  extensors  of  thumb 


Superficiales  vol(f 
Superficial  palmar  arch 


Brachial  artery 
Basilic  rein 

ULNAR  NERVE 

MEDIAN  NERVE 

Anastomolica  magna 
Brachial  artery 

INTERNAL  CONDYLE 


Ulnar  artery 
Pronator  radii  teres 
Plexor  carpi  ulnaris 

Flexor  sublimis  digitorum 
Flexor  carpi  radialis 
Palmaris  longus 

MEDIAN  NERVE 
Flexor  sublimis  digitorum 

Ulnar  artery 
PISIFORM  BONE 

Anterior  annular  ligament 
Palmaris  brevis 


THE  FOREARM 


103 


FIG.  1 14. — THE  ARTERIES  OF  THE  RIGHT  FOREARM  AND  THE  DEEP  PALMAR  ARCH. — (Morris.) 


Inferior  profunda  artery 
Anculomotica  magnet  artery 


Biachial  artery 
Radial  recurrent  artery . 

Supinator  longus 
Radial  artery. 


Plexor  longus  pollicis  muscle 


-Brachialis  anticus  muscle 

Anterior  ulnar  recurrent 

l 
1  Posterior  ulnar  recurrent 

-Ulnar  artery 

Anterior  interosseous  artery 
Flexor  carpi  ulnaris 

Flexor  profundus  digitorum  muscle 
Anterior  interotseou*  artery 


Anterior  annular  ligament,  cut  • 


Anterior  branch  of  ulnar  artery,  cut 
.  Deep  palmar  arch 

•  Palmar  interosseous  arteries 
Palmar  digital  artery,  cut  thorl 


Collateral  branch  of  palmar  digital  artery 


104 


THE  FOREARM 


FIG.  115. — THE  BACK  OF  THE  LEFT  FOREARM,  WITH  THE  POSTERIOR  INTEROSSEOUS  ARTERY 

AND  BRANCHES  OF  THE  RADIAL  AT  THE  BACK  OF  THE  WRIST.— (Morris.) 

(From  a  dissection  in  the  Hunterian  Museum.) 


Articular  branch  of  superior 
profumla 

Brachialis  antieua 
Supinator  lougus,  cut 


Common  extensor  tendon 


Extensor  carpi  radialis  longior 
and  brevior 


Supinator  brevis 
Posterior  interosseous  artery 


Extensor  ossis  metacarpi  pollicis 
Supinator  longus,  cut 

Extensor  primi  internodii  pollicis 


Posterior  annular  ligament 

Extensor  carpi  radialis  longior 

Radial  artery 

Dorsalis  pollicis  artery 

Extensor  secundi  internodii* 

pollicis 

First  dorsal  interosseous  muscle 

Dorsalis  indicts  artery 

Princeps  pollicis  artery 


Dorsal  digital  artery 


Triceps 


Rete  over  olecranon 
Interosseous  recurrent  artery 

Anconeus,  cut 


xtensor  carpi  uluaris 
.exor  carpi  ulnaris 


rigin  of  extensor  secundi  and 
indicator 


is/erior  branch  of  anterior  interosseous 

artery 
terosseous  membrane 


terior  ulnar  carpal  artery 
ctensor  carpi  radialis  brevior 

sterior  radial  carpal  artery 

ird  dorsal  interosseous  artery 
cond  dorsal  interosseous  artery 
Metacarpal  or  first  dorsal  interosseous 
artery 


THE  HAXD 


105 


HAND. 


Muscles : — 
Palm:— 

Palmaris  brevis. 

Lumbricales. 

Interossei — tlwse  are  best  exposed  later.    (Figs.  119  and  1 20.) 

Thenar  eminence.     (Fig.  118.) 

Abductor  pollicis. 

Opponens  pollicis. 

Flexor  brevis  pollicis. 

Adductor  pollicis. 


FIG.   1 1 6. — SUPERFICIAL  NERVES  OF  THE  PALM.     (Ellis.)     (Morris.) 


MEDIAX  SERVE 


BRANCH  TO  MUSCLES 
OF  THUMB 


COLLATERAL 

BRA. \ffn.s 
MEDIA* 


ULSAR  SERVE 


COMMUSICA  TIOS 
BETWEEN  MEDIAN 
ASD  ULSAR 


COLLATERAL 
BRANCHES  OF 
UJJTAJt 


Hypothenar  eminence.     (Fig.  118.) 
Abductor  minimi  digiti. 
Flexor  brevis  minimi  digiti. 
Opponens  minimi  digiti. 
Trace  out  the  arteries  and  nerves  of  hand. 


io6  THE  HAND 

Arteries.     (See  Figs.  114,  115  and  124):- 
Superficial  palmar  arch. 
Deep  palmar  arch. 
Dorsal  interosseous. 
Dorsalis  indicis. 
Princeps  pollicis. 
Dorsal  digital. 


FIG.   117. — A  DISSECTION  OF  THE  CUTANEOUS  NERVES  ON  THE  DORSAL  ASPECT  OF  THE 

HAND  AND  FINGERS.     (H.    St.  J.  B.)    (Morris.) 
The  branches  of  the  median  nerve  are  shown  in  black. 


DORSAL  BRANCH 
Of  ULNAR 


BRAXCH  OF 

MEDIA  \ 
NER  VE 


BRANCH  OF  MVSCVLO-SPIRAL 


RADIAL  XER  VE 


See  Figs,  in,  112  and  116. 
Nerves : — 

Median. 

Ulnar. 

Radial. 


THE  HAND 


107 


. THE  SUPERFICIAL  MUSCLES  OF  THE  PALM  OF  THE  HAND. — (Morris.) 


Flexor  carpi  radialis 


Extensor  ossis  metacarpi  pollicis 


Opponens  pollicis 


Abductor  pollicis 


Flexor  brevis  pollicis 


Adductor  pollicis 


First  lum- 

bricalis 

First  dorsal 

interoe- 

seous 


Ligamentum  vaginale 

Flexor  sublimis  digitorum 


Flexor  profundus  digitorum 


Flexor  profundus 
digitorum 


io8 


THE  HAND 

FIG    119. — THE  PALMAR  INTEROSSEI. — (Morris.} 


FIG.   120. — THE  DORSAL  INTEROSSEI. — (Morris.} 


After  completing  the  dissection  of  the  forearm,  wrist,  and  hand  place  the 
parts  in  their  proper  position  and  study  the  relation  each  part  bears  to  its  sur- 
roundings. 


ANASTOMOSES  OF  ARTERIES  OF  UPPER  EXTREMITY 


109 


Examine  the  anastomoses  of  the  arteries  of  the  upper  extremity  shown 
in  the  following  figures. 


FIG.   121. — THE  ANASTOMOSES  ABOUT  THE  SCAPULA. — (Morris.) 

Snliscnpitlar  branch  <>J  suprascnpitlar  artery 
Sttpraspinous  branch  of  suprascapular  artery 


Posterior  scapular  artenj 


Supraitfiinaus  branch 
of  posterior  scapular 
artery 

Subscapular  branch 
of  posterior  sc/apular 
artery 


Branch  of  intercostal 
artery 


Branch  of  intercostal 

artery 

Continuation  of  posterior 
scapular  artery 


Suprascapular  artery 


Acromial  branch 
ofacrontio- 
thoracic 

Acromial  rete 


bscapular  branch 

of  suprasca  imlur 

artery 
Infraspinous  branch 

of  suprascupular 

artery 
Sttbxcafmlar  branch 

of  axillary  artery 


Dorsal  scapular  branch  of 
subscapnlar  artery 


Infrascajnilar  branch  nf 
dorsal  scapular  artery 


Continuation  of  tub- 
scapular  artery 


no          ANASTOMOSES  OF  ARTERIES  OF  UPPER  EXTREMITY 


FIG.    122. — DIAGRAM  OF  THE  ANASTOMOSES  OF  THE   BRACHIAL  ARTERY 
(MacCormac  and  Anderson.)     (Morris.) 


Anterior  circumflex 
Posterior  circumflex 


Superior  radial  collateral  (exces- 
sively large) 


Superior  profunda 


External  posterior  articular  branch 
of  superior  nrojunda 


External  anterior  articular  branch 
of  superior  profunda 


Posterior  inlerosseous  recurrent 


Radial  recurrent 
Posterior  interosseous  recurrent 


A  cromio-thoracic 
Long  thoracic 

—  Subscapular 
—  Dorsalis  scapulae 


Posterior  scapular 


Anaslomotica  magna 

Transverse  branch  of  anastomotica  magna 

Anastomosis  of  anterior  ulnar  recurrent  with 
anaslomotic 


—  Anastomosis  of  posterior  ulnar  recurrent  with 

anaslomotic 

(  —  Anterior  ulnar  recurrent 

—  Posterior  ulnar  recurrent 


Posterior  interosseous  from  common  interosseous  of  ulnar 


ANASTOMOSES  OF  ARTERIES  OF  UPPER  EXTREMITY 


FIG.  123. — DIAGRAM  OF  THE  RELATION  OF  THE  ARTERIES  OF  THE  LEFT  FOREARM  TO  THE 
BONES.  (Walsham.)  (Morris.) 


Inferior  profunda  artery 
Brachial  artery 


Anastomolica  magna  artery 

Anterior  ulnar  recurrent 
Posterior  ulnar  recurrent 

Ulnar  artery 
Common  interosseous  artery 


Anterior  interosseous  artery 


Anterior  ulnar  carpal 

Superficial  branch  of  ulnar  artery 
(superficial palmar  arch) 

First  palmar  digital  artery 


Superior  profunda  artery 


EXTERNAL  CONOVLE 

Articular  branch  of  superior 
profunda  artery 

Radial  recurrent  artery 
Interosseous  recurrent  artery 

Radial  artery 
-  Oblique  ligament 


Interosseous  membrane 
Posterior  interosseous  artery 


Anterior  radial  carpal 
Radial  artery  at  wrist 

Superficial  volar  branch  of 
radial  artery 


lmar  arch 


ANASTOMOSES  OF  ARTERIES  OF  UPPER  EXTREMITY 


FIG.  124. — ANASTOMOSES  AND  DISTRIBUTION  OF  THE  ARTERIES  OF  THE  HAND.     (Walsham.) 

(Morris.) 


Anterior  interosseous 

Radial  artery 

Anterior  radial  carpal 


Superficial  volar 
Posterior  radial  carpal 
Radial  artery  at  wrist 


Dorsalis  pollicis 

Metacarpnl  or 

first  dorsal 

interosseous 

Princeps  pollicis  — 


Dorsalis  indicis 


Radialis  itnlicis 


First  dorsal  branch  of  collateral 
digital 


Second  dorsal  branch  of  collateral 
digital 


Anastomosis  of  collateral  digital 
arteries  about  matrix  of  nail 
and  pulp  of  finger 


Ulnar  artery 

/L_  Anterior  ulnar 
carpal 

Posterior  ti/nar 
carpal 


Deep  ulnar 
Superficial  arch 

Carpal  recurrent 

Posterior  comnttnn- 
cnting  or  perforat- 
ing 

Palmar  interosseous 


Second,  third,  and 
fourth  pulmar 
digital 

Second  and  third 
dorsal  intei'osxeoits 

First  palmar  digital 


Anterior  comnwni- 
rntiity  or  perforat- 
ing 


ARTICULATIONS 


DEMONSTRATION  XVI. 

ARTICULATIONS  AND  LIGAMENTS. 

Classes  of  articulations. 

Various  movements  of  joints. 

Expose  the  ligaments  in  the  following  articulations: 

Articulations  of  vertebral  column. 

1.  Connecting  the  bodies  of  the  vertebras. 

2.  Connecting  the  laminas. 

3.  Connecting  the  articular  processes. 

4.  Connecting  the  spinous  processes. 

5.  Connecting  transverse  processes. 


FIG.  125. — POSTERIOR  VIEW  OF  THE  STERNO-COSTO-CLAVICULAR  JOINT. — (Morris.} 


Posterior 
portion  of 

Interclavicular     capsule 
ligament 


Rhomboid 
ligament 


Sterno-costo-clavicular. 

Scapulo-clavicular. 

Shoulder- joint. 

Elbow-joint. 

Radius  with  ulna. 

Radio-carpal. 

Carpal. 

Carpo-metacarpal. 

Interphalangeal. 


ARTICULATIONS 


FIG.  126. — ANTERIOR  VIEW  OF  STERNO-COSTO-CLAVICULAR  JOINT. — (Morris.) 


FIG.  127 .—SECTION  THROUGH  STERNO-CLAVICULAR  JOINT. — (Morris.) 


The  Jaterarticular 
flbro-cartilage 


The  joint  between 
the  sternum  and 
second  costal  car- 
tilage 


ARTICULATIOXS 


FIG.  128. — ANTERIOR  VIEW  OF  SHOULDER,  SHOWING  ALSO  CORACO-CLAVICULAR  AND  CORACO- 

ACROMIAL   LIGAMENTS. — (Morris.) 


Conoid  ligament 


Transverse  scapular  ligament 


Trapezoid  ligament 


Coraeo-acromial  ligament 

^ Short  head  of  biceps 

Subscapular  tendon 

Capsule  of  shoulder 


Long  tendon  of 
biceps 


FIG.  129. — POSTERIOR  VIEW  OF  THE  SHOULDER-JOINT,  SHOWING  ALSO  THE  ACROMIO-CLAVI- 

CULAR  JOINT  AND  THE  SPECIAL  LlGAMENTS  OF  THE  SCAPULA. (Morris.) 


Conoid  ligament 


Acromio-clavicular 
ligament 


Tendon  of  infra- 
spinatus  and  teres 
minor 


Transverse  ligament 


ARTICULATIONS 


FIG.    130. — VERTICAL    SECTION    THROUGH    THE    SHOULDER-JOINT    TO    SHOW    THE    GLENO- 

HUMERAL  LIGAMENT. — (Morris.} 
(The  joint  is  opened  from  behind.) 


Supra-spinatuB 
muscle 

Subacromial  bursa 
Tendon    of    biceps 

with  gleno-hume- 

ral  ligament 
Tendon  of  subsca-  _ 
oularis 


Capsular  ligament  — 


Suprascapular 
ligament 


Olenoid  ligament  or  nbro-cartilage 


FIG.   131. — INTERNAL  VIEW  OF  THE  ELBOW-JOINT. — (Morris.) 


Oblique 
ligament 

Upper  edge 
of  inter- 
osseous 
membrane 


ARTICULATIONS 


117 


FIG.   132. — EXTERNAL  VIEW  OF  THE  ELBOW-JOINT. — (Morris.} 

k 


Orbicular  ligament 


External  lateral 
ligament 


Posterior  ".igament 


FIG.   133. — ANTERIOR  VIEW  OF  WRIST. — ( 


Anterior  radio-ulnar 
ligament 

Internal  lateral  liga- 
ment of  wriat 
Plexor  carpi  ulnaris 


External  lateral  ligament 

of  wrist 
Anterior  radio-carpal 

ligament 

Tendon  of  flexor  carpi 
radialis 


Capsular  ligament  of  first 
carpo-metacarpal  joint 


u8 


ARTICULATIONS 


FIG.    134. — POSTERIOR   VIEW    OF    WRIST. — (Morris.) 


Posterior  radio-carpal 

ligament 


Capsule  of  carpo-meta- 
carpal  joint  of  thumb 


Posterior  radio- 

ulnar  ligament 


Internal  lateral 
ligament  of  wrist 


FIG.  135. — ANTERIOR  AND  POSTERIOR  VIEW  OF  LIGAMENTS  OF  THE  FINGERS. — (Morris.) 


Transverse  ligament 
between  the  heads 
of  the  metacarpal 
bones 

Glenoid  ligament 
Lateral  ligament 


Areolar  tissue 
capsule 

Lateral  ligament 


Glenoid  ligament 
Lateral  ligament 


Flexor  tendon 


Flexor  tendon 


Areolar  tissue 

capsule 
Lateral  ligament 

Extensor  tendon 


Slips  of  the  extensor  . 
tendon 


ARTICULATIONS 


119 


FIG.  136. — SYNOVIAL  MEMBRANES  OF  WRIST,  HAND,  AND  FINGERS. — (Morris.) 


Synovial  sac  of  the  inferior  radio- 
uluar  joint 


Synovial  sac  of  the  carpus 


Synovial  sac,  occasionally  separate, 
for  the  fourth  and  fifth  metacar- 
pal  bones 


Lateral  ligaments  of  the  metacarpo- 
phalaugeal,  and  iuter-phalangeal 
joints 


Study  the  nerve-  and  blood-supply  of  each  joint. 


I2O 


CUTANEOUS  NERVES 


Showing  the  cutaneous  nerve  supply  of  the  body. 


FIG.  137. — DIAGRAM  OF  THE  CUTANEOUS  NERVE  AREAS  OF  THE  HEAD  AND  NECK. — (Morris.) 


SMALLEST 
OCCIPITAL 


X INFRA   ( 
OR£ITAL\t 


DESCENDING    CER  VfCA  L 


SMALL     \. 
OCCIPITAL 


TEMPORAL 

SUPRA 
T  ROC  H LEAR 

LACHRYMAL 

INFRA 
ROC  H  LEAR 


NASAL 


CUTANEOUS  XERVES 


FIG.    138. — DIAGRAM  SHOWING  THE  AREAS  OF  DISTRIBUTION  OF  CUTANEOUS   NERVES. — 

(Morris,) 

HEAD:— 

Red — First  division  of  fifth,  \\hite — Second  division  of  fifth.  Blue — Third  division  of  fifth.  Dark  area — Posterior 
primary  divisions  of  cervical  nerves.  Oblique  and  transverse  shading — Branches  of  cervical  plexus. 

BOD*  AND  LIMBS: — 

Red — Anterior  divisions  of  anterior  primary  branches.  Blue — Posterior  di  visions  of  anterior  primary  branches.  Two 
colors  in  one  area  indicate  that  the  area  is  supplied  by  two  sets  of  nerves,  and  it  should  be  understood  _that 
wherever  two  nerve  areas  approach  each  other  they  overlap.  The  dotted  blue  area  of  small  sciatic  indi- 
cates that  the  nerve  comes  from  the  posterior  as  well  as  from  the  anterior  parts  of  anterior  primary  divisions 
of  sacral  nerves,  but  it  supplies  a  flexor  area.  The  area  of  the  perforating  cutaneous  nerve  is  left  uncoloured 
because  its  true  nature  is  uncertain.  Dark  shading — Posterior  primary  divisions.  The  numbers  and  initial 
letters  refer  to  the  nerve-roots  from  which  the  nerves  are  derived. 


Front 


Back 


Itt  DIVISION  OF  5th  - 


3d  DIVISION  OF  oth  - 

td  DIVISION  OF  oth  

GREA  T  A  URICULAR 

t,3C,  SUPERFICIAL  CERVICAL  


SUPERFICIAL 
DESCEXDIXG  CERV. 

CIRCUMFLEX 
LATERAL  fTTAXEOUS 
JKKSKB8 

AXTERluR   CUTAXE- 
-   XERVE* 


IXTEKXAL   CCTAXg- 
t.V/>    fXTERCOSTO-BC-     — 

MERAL,  I.  S  D 

CPPER   EXTERNAL    CCTAXB-  _. 
OL'S  OF  MCSCI'LO-SPIRAL 

IXTERXALCUTAXEOUS  - 


MUSCULO-CUTAXEOUS  


EXTERXA  L 
CUTANEOUS 


GEXITO-CRURAL 
RADIAL,  6  C 

IXGI'IXAL.  I  L 
If  ED  I  AX,  g,  7,  S  C,  I  D    - 

ULXAR,  1  D  ~. 


IXTERXA  L  CUT  A  XEO  US 
MIDDLE  CUTANEOUS 


EXTERNAL  POPLITEAL  ~ 
IXTERXAL  SAPHEXOUS  - 


SUPRAORBITAL 

GREAT  OCCIPITAL 
SMALL  OCCIPITAL 
SMALLEST  OCCIPITAL 
GREA  T  A  URICULAR 

POSTERIOR  PRIMARY  Diri- 
SIOA'S  OF  CERVICAL  SERVES 


SUPERFICIAL  DE- 
1>ISG  CERVI- 
CAL,:, UC 

CIRCUMFLEX,  5,  6  C 

LATERAL  BRAXCHES  OF 
DORSAL  XERTES 

UPPER  ESTERXAL    CCTAXX- 
OCS  OF  MrSCVLO-SPIRAL 

IXTERCOSTO-Hl'MERAL    AXD 
LESSER  1XT.  CrTAXEOCS 

IXTERXAL  Cl'TAXBOCS  OF 
MrSCCLO-SPIRAL 


LOWER  E.TTERXAL  OF 


'LO-CUTAXEOUS 


EXTERNAL  SAPHEXOUS 

AXTERIOR  TIBIA  L  ~~ 

IXTERXAL  PLA.\TAR 


IXTERXAL  CCTAXEOCS 
POSTERIOR  PRIMARY 
LL'MBAR 

LATERAL  CCTAXKOCS  OF 

ILIO-HTPOGA  S  TRir 

.  s.tc 


POSTERIOR  PRIM.  SACRAL 
PERFORA  TIXO 
CCTAXEOCS  OF  td 
AKD  3d  SACRAL 

—  l'L\AS,8C 

-  £  A  DIAL,  6,7  C 

—  AREA  SUPPLIED   BT 

RADIAL  Axr>  I-LXAX 
XERTSS 

ir.   -  JfEDfAX,  6,  7,  8  C, 
ID 


EXTERXAL  CUTAXEOUS 

SMALL  SCIATIC 


IXTERXA  L  CUT  A  XFO  US  A  XD 
OBTURATOR 


EXTERXAL  POPLITEA  L,5  L,1,SS 
IXTERXAL  SAPHEXOUS,  3,  U  L 

„  EXTERXAL  SAPHEXOUS,  1, 1 S 


CALCAXEO-PLAXTAR  (Post- 
tihial),  1,SS 


EXTERXAL  PL  A  XT  A  R,  1,  t  S 
IXTERXAL  PLAXTAR,  '„  5  L,1S 


122 


TRANSVERSE  SECTIONS 


An  examination  of  the  following  figures  will  help  to  understand  and 
remember  the  relative  positions  of  the  structures  exposed  by  the  sections. 


FIG.    139. — SECTION    OF    NECK   THROUGH    THE    SIXTH   CERVICAL   VERTEBRA.      (One-half.) 

(Braune.)     (Morris.} 

RECURRENT  LARYNGEAL  NERVE 

PHARYNX  i  LARYNX 


Longus  colli  muscle 
Superior  thyroid  artery 
DESCENDENS  NON1 

VAGUS 
PHRENIC  NER  VE 


Soalenus  anticus 
Sterno-oleido-mastoid 


BRACHIAL  PLEXUS 

Scalentia  medius 
External  jugular  rein 

SPINAL  ACCESSORY 
NERVE 


SpleniuB 

PART  OF  ARTICULAR  SURFACE  OF  SEVENTH  CERVICAL  VERTEBRA 

Semi-spinalis  and  multifidua 

SIXTH  CERVICAL  VERTEBRA 


Thyro-aryteuoid  muscle 

CRICOID  CARTILAGE  (and  omo-hyoid  muscles 

Sterno-hyoid  (just  posterior  are  seen  the  thyro- 
Crico-arytenoideus  lateralis 

Muscular  process  of  the  thyroid  cartilage 


THYROID  GLAND 


Common  carotid  artery 
Internal  jugular  vein 

BRACHIAL  PLEXUS 

Scalenus  medius 
External  jugular  vein 
Scalenus  posticus 

SPINAL  ACCESSORY 
NER  VE 


Levator  anguli  scapulae 


Cervicalis  ascendens 
Transversalis  cervicis  and  traehelp- 
Profunda  cervicis  vessels 
Trapezius 


Biveuter  cervicis  and  complexus 


FIG.  140. — DIAGRAM  SHOWING  RELATION  OF  KIDNEY  TO  CAPSULE. — (Morris.) 


TRANSVERSE  COLON 


DESCENDING  COLON 

PERITONEUM 

FATTY  CAPSULE 

KIDNEY 
PERITONEAL  CAVITY 


Diaphragmatic 
fascia 


Parietal  muscle 


CUT  EDGE  OF 
PERITONEUM 

Muscular  fibre  in 
subperitoneal 
tissue 

PANCREAS 


Sup.  mesenteric  vein 
DUODENUM 


LYMPHATIC  GLAND 


LUMBAR  VERTEBRA 


SUBPERITONEAL  TISSUE        FATTY  CAPSULE        Renal  vessels  embedded  in  mbperitoneai  tissue 


TRANSVERSE  AND  SAGITTAL  SECTIONS 


123 


FIG.  141.—  TRANSVERSE  SECTION  OF  THE  ABDOMEN  THROUGH  THE  KIDNEYS  AND  PANCREAS. 
AT  THE  LEVEL  OF  THE  FIRST  LUMBAR  VERTEBRA.     (Braune.)     (Morris.) 

Inferior  caro 


Bound  ligament 
RectuB 

EIGHTH  RIB 


STOMACH 


8I6MOID  FLEXURE 

DESCENDING  COLON 
External  oblique 

PANCREAS 


SPLEEN 


TRANSVERSE  COLON 
/  SEVENTH  RIB 

ASCENDING  COLON 


DUODENUM 


EIGHTH  RIB 

Obliquus  eiternns 
NINTH  RIB 
PLEURA 
TENTH  RIB 


Splenic  rtin 

Descending  aorta 
BODY  OF  FIRST  LUMBAR  VERTEBRA      TWELFTH  RIE 


LIVER 
Diaphragm 


ELEVENTH  RIB 


FIG.  142. — SAGITTAL  SECTION  OF  MALE  PELVIS  IN  THE  MESIAL  LINE.    (One-third.)    (Braune.) 

(Morris.) 


BLADDER 


F.ES 


BULB 


-  POUCH  OF  DOUGLAS 

-  RECTUM 

-  FOLD  OF  HOUSTON 

-  VESICULA  SEMINAUS 

!J~  DUCTUS  EJACULATORIUS 
L.  PROSTATE 

—  External  sphincter 

—  |  Internal  sphincter 

External  sphincter 


i24  SAGITTAL  AND  TRANSVERSE  SECTIONS 

FIG.  143. — SECTION  OF  THE  FEMALE  PELVIS.     (After  Henle.)     (Morris.} 


VESICAL  WALL 

CAVITY  OF  BLADDER 

Prevesical  fat 


Deep   transver- 
sus  perinaei 


RECTUM 

COCCYX 

Recto-coccy- 
geal  muscle 
POSTERIOR  LIP  OF  08 

UTERI 
ANTERIOR  LIP 

VAGINA 

External 
sphincter  ani 

Internal 
sphincter  ani 


LABIUM  MAJUS 
Unstriped  muscular  fibre 


URETHRA 
LABIUM  MINUS 


ANUS 

Internal  sphincter  ani 
Fart  of  external  sphincter  ani 


Unstriped  muscular  fibre  Vessels 

VAGINAL  ORIFICE 


FIG.  144. — SECTION  SHOWING  THE  ISCHIO-RECTAL  FOSSA  IN  ITS  RELATIONS  TO  THE  PELVIC 

VISCERA. — (Morris.) 


OS  PUBIS 
Muscles 


Levator  ani  with  recto-vesical 
and  ischio-rectal  fasciae 


Obturator  internus 


Internal  pudie  vessels  and 

NER  VES  in  obturator  fascia 

TUBER  ISCHII 

Ischio-rectal  fossa  with  its 
anterior  and  posterior  ex- 
tensions 


Gluteus  maximus 


SYMPHYSIS  PUBIS 


Pubo-prostatic  ligaments 
Proslatic  plexus 
PROSTATE 

Capsule  of  prostate  formed 

by  recto-vesical  fascia 
Fat 


RECTUM  INVESTED  BY  RECTO- 
VESICAL  FASCIA 


SECTION  OF  SHOULDER-JOINT 


125 


FIG.    145. — TRANSVERSE   SECTION   THROUGH   THE   RIGHT   SHOULDER-JOINT,   SHOWING  THE 
STRUCTURES  IN  CONTACT  WITH  IT.     (Braune.)     (Morris.) 


CLAVICLE 

ACROMION 
Supra-spinatus 

Trapezius 
Infra-spinatus 


Teres  minor    4 


Teres  major 
Latiasimus  dorsi 


Pectoral  is  major 

Axillary  vessels  and  NER  VES      Tendon  of  subscapularis  blended  with 

the  scapular  ligament 
Coraco-brachialis  and  short  head  of  biceps 


FIG.   146. — DIAGRAMMATIC  SECTION  OF  SHOULDER  THROUGH  BICIPITAL  GROOVE. 

(Anderson.)      (Morris.) 


Deltoid 

SUBACROMIAL  BURSA 

CAPSULE  OF  SHOULDER-JOINT 
Long  tendon  of  biceps 

Synovial  membrane  lining 
capsule  and  synovial 
membrane 


Extra-articular  portion  of 
bicepa  tendon 


• —  Glenoid  ligament 


GLENOID  CAVITY 


Glenoid  ligament 


Inner  fold  of  capsule  and 
synovial  membrane 


126 


ARM  AND  ELBOW 


FIG.     147. — SECTION    THROUGH    THE    MIDDLE    OF    THE    RIGHT    UPPER    ARM.      (Heath.) 

(Morris.) 


Cephalic  vein 

MUSCULO-CUTANEO  US 
NER  VE 
Brachialis  anticus 


MUSCULO-SPIRAL  NERVE 
Superior  profunda  vessels 


Triceps,  with  fibrous  intersection 


Biceps 

Brachial  vessels 

-  MEDIA  N  NER  VE 
ULNAR  NERVE 
Basilic  vein,  u-ith  internal 
cutaneous  nerves 


Inferior  profunda  vessels 
FIG.  148. — VERTICAL  SECTION  OF  THE  ELBOW.    .  (One-half.)     (Braune.)      (Morris.) 


Tendon  of  biceps 

Brachio-radialis 
RADIAL  NERVE 

Brachialis  anticus 
Extensor  carpi  radialis  longior 


Anconeus 


Pronator  teres 
MEDIAN  NERVE 


- —  Flexor  carpi  radialis 


Internal  lateral  ligament 
ULNAR  NERVE 

OlECRANON 
Tendon  of  triceps 


FIG.    149. — LONGITUDINAL    SECTION    OF    THE    ELBOW-JOINT.     (One-half.)     (Braune.) 

(Morris.) 


Triceps 


Extensor  carpi  nlnaris 


Biceps 


Brachialis  anticus 


MUSCUL  0-SPIRA  L  NER  VE 
Brachio-radialis 


Supinator  brevis 


Extensor  carpi  radialis  longior 


FOREARM  AND  }VRIST 


127 


FIG.  150. — SECTION  -THROUGH  THE  MIDDLE  OF  THE  RIGHT  FOREARM.      (Heath.)      (Morris.) 


Brachio-radlalis 


Supinator  brevis 

Extensor  carpi  radialis 
longior  and  brevier 

Extensor  ossis  metacarpi 
pollicis 


Extensor  communis  digitorum 

Extensor  carpi  ulnaris 
Posterior  interosseous  vessels  and  NERVE 


Flexor  sublimis  digitorum 


Flexor  carpi  ulnaris 


Ulnar  vessels  and  NERVE 
Flexor  profundus  digitorum 
MEDIAN  NERVE 


Extensor  secundi  iuternodii  pollicis 


FIG.    151. — SECTION   THROUGH   REGION   OF   WRIST,    A   LITTLE   ABOVE   THE   JOINT.     RIGHT 
SIDE,  UPPER  HALF  OF  THE  SECTION.      (Tillaux.)     {Morris.) 


Flexor  carpi  radialis 
Radial  artery 


Brachio-radialis 


Flexor  longus  pollicis 
/     Flexor  sublimis 

Flexor  profundus 

Pronator  quadratus 


RADIAL  NERVE 


Extensor  ossis  meta- 
carpi pollicis 
Extensor  primi 
internodii  pollicis 


Extensor  carpi  radialis 

longior 
Extensor  carpi   radialis 

brevior 


Extensor  secundi  internodii 
pollicis 


Ulnar  artery,  mnrr 
internal ly    the    NERVE 

Anterior  interosseout 
artery 


Flexor  carpi  ulnaris 


RADIUS 


Extensor  carpi  ulnaris 
Extensor  minimi  digiti 


Extensors  corn- 
munis  and  indicis 


128 


SECTION  OF  THE  WRIST 


FIG.  152. — TRANSVERSE  SECTION  OF  THE  WRIST,  THROUGH  THE  MIDDLE  OF  THE  PISIFORM 

BONE. — (Morris,} 


Sheath  of  flexores  sublimis  and  profundus  digitorum  and  flexor  longus  pollicis, 
enclosed  by  the  annular  ligament 


Cut  tendon  of  palmaris  longu 

SEMILUNAR  BONE 


ULNAR  NERVE 

Ulnar  vessels 


Sheath  for  flexor  carpi  radialis 
Radial  origin  of  annular  ligament 

Sheath  for  extensor  ossis  metacarpi 
and  primi  internodii  pollicis 

Radial  vessels 

Sheath  for  extensor  ossis  metacarpi 
and  primi  internodii  pollicis 

OS  MAGNUM 

Sheath  of  extensor  secundi 
internodii  pollicis 


Sheath  of  extensores  carpi  radialis,  longior  and  brevior 


Sheath  of  extensor  communis  and  indicator 


-  CUNEIFORM 


Sheath  of  extensor  carpi 
ulnaris 


Sheath  of  extensor  minimi  digiti 

CUNEIFORM 
UNCIFORM 


FIG.  153. — SECTION  OF  CARPUS,  THROUGH  THE  UNCIFORM  BONE. 

after  Henle.)      (Morris.) 


(Two-thirds.)      (Bellamy 


MEDIAN  NERVE 
Plexor  longus  pollicis     Flexores  sublimis  and  profundus 


Flexor  carpi  radialis 

Thenar  muscles 
BASE  OF  FIRST  METACARPAL  BONE 


Ulnar  vessels  and  NER  VE 


Palmaris  brevis 

Hypothenar  muscles 


Extensor  ossis 
metacarpi  pollici 
TRAPEZIUM 

Extensor  primi  internodii 

pollicis 

Radial  vessel, 

Extensor  carpi  radialis  longior- 


TRAPEZOID 
External  carpi  radialis  brevior 


Extensor  carpi  ulna  via 
Extensor  minimi  digiti 
UNCIFORM 


OS  MAGNUM    Extensor  communis  digitorum 
Extensor  indicis 


SECTION  OF  HAND 


129 


FIG.  154. — HORIZONTAL  SECTION  OP  THE  HAND  THROUGH  THE  CARPO-METACARPAL  JOINTS. 

(Bellamy  after  Henle.)     {Morris.) 


Volar  aponeurosis 
Flexor  tendon  in  the  sheath     Inter-osseous 

Lumbricales 
Flexor  tendon  in  the  sheath 


Deep  volar  aponeurosis 

Lumbricales 
Anterior  carpal  ligament 

Flexor  tendon  in  the  sheath 
Deep  volar  aponeurosis   I 
Iiumbric 


Lumbricales 

Anterior  carpal  ligament 
f  Flexor  tendon  in  the  sheath 
Hypothenar  muscles 


FIG.    155. — DIAGRAM  OF   A  VERTICAL  SECTION  THROUGH  THE  MIDDLE  OF  THE  HAND. 

(Morris.) 


Posterior  annular  ligament 


Deep  transverse  ligament 
Attachment  of  common  extensor 
to  first  phalanx 


Superficial  transverse  ligament 


Vincula  accessoria 


Attachment  of  common  extensor 
to  second  phalanx 


Attachment  of  common  extensor 
to  third  phalanx 


Great  palmar  bursa 


Anterior  annular  ligament 


Dorsal  inter-osseous 
Lumbricalis 
Palmar  fascia 

Flexor  profundus  digitorum 
Flexor  sublimis  digitorum 


Theca 


Ligameutum  vaginale 
Vincula  accessoria 


PART  II. 


ABDOMEN,  ABDOMINAL  VISCERA,  PELVIS,  PELVIC  VISCERA, 
AND  LOWER  EXTREMITIES. 


DEMONSTRATION  I. 
THE  ABDOMEN. 

Surface  Anatomy. — Umbilicus,  linea  alba,  recti  muscles,  and  linea  semi- 
lunaris,  should  be  located.  The  external  abdominal  ring  can  be  felt  above 
and  external  to  the  spine  of  the  pubis.  Passing  from  the  spine  of  os  pubis 
to  the  anterior  superior  spine  of  the  ilium  is  Poupart's  ligament. 

The  external  abdominal  ring  in  the  male  can  be  felt  by  passing  your 
finger  along  the  spermatic  cord  beginning  at  the  testes. 

In  order  that  the  viscera  in  the  abdomen  may  be  more  easily  located 
the  abdomen  is  divided  into  regions  by  drawing  one  line  horizontally  across 
the  abdomen  on  a  level  with  the  cartilages  of  the  ninth  ribs ;  another  on 
a  level  with  the  anterior  superior  spines  of  the  ilia.  Then  draw  a  vertical 
line  on  each  side  from  the  cartilages  of  the  eighth  ribs  to  the  middle  of 
Poupart's  ligament.  This  divides  the  abdomen  into  epigastric,  umbilical, 
hypogastric,  right  and  left  hypochondrium,  right  and  left  lumbar,  right 
and  left  inguinal  regions. 

FIG.  156. — (Holden.) 


134  THE  ABDOMEN 

Another  division  can  be  made,  shown  in  figure  157,  from  Morris: — 


FIG.   157. — DIAGRAM  OF  THE  ABDOMINAL  REGIONS. — (Morris.} 


Joint    between    meeo-Bter- 
num  and  ensiform  cartilage 


Tip  of  ensiform  cartilage 
Costal  border 


UPPER  HORIZONTAL  PLANE 


LOWER  HORIZONTAL  PLANE  A,  Al 
LEVEL  OF  TUBERCLES  OF  ILIAC 
CREST 

LOWER  HORIZONTAL  PLANE  B,  AT 
LEVEL  OF  ANTERIOR  ILIAC  SPINES 


VERTICAL  PLANE  A,  FROM  MIDDLE  OF 
POUPART'S  LIGAMENT 


VERTICAL  PLANE  B,  AT  OUTER  BOR- 
DER OF  RECTUS  (SEMILUNAR  LINE) 


SUMMIT  OF  SYMPHYSIS  PUBIS 


What  viscera  are  in  each  region  ? 


THE  ABDOMINAL  WALLS 


135 


DEMONSTRATION  II. 

ABDOMINAL  WALLS. 

Make  a  circular  incision  through  the  skin  around  the  umbilicus  one  and 
one-half  inches  in  diameter;  turn  the  skin  toward  the  umbilicus.  This  serves 
to  hold  a  string.  Now  make  a  puncture  through  the  umbilicus,  insert  a  blow- 
pipe, distend  the  abdomen  with  air,  remove  blow-pipe,  and  draw  the  string 
tight. 

Dissection. — Make  an  incision  through  the  skin  from  the  ensiform 
cartilage  to  the  os  pubis,  another  midway  between  the  umbilicus  and  os 
pubis,  transversely  outward  to  the  anterior  superior  iliac  spine  and  along 
the  crest  of  the  ilium  to  its  posterior  third.  Another  from  the  umbilicus 
upward  and  outward  to  the  sixth  rib.  Dissect  off  the  skin,  exposing  the 
superficial  fascia. 

Study  the  superficial  fascia  and  note  in  it  the  following: — 

Superficial  arteries  (Fig.  158): — 
Superficial  epigastric. 
Superficial  circumflex  iliac. 
Superficial  external  pudic. 


FIG.  158. — SUPERFICIAL  VESSELS  AND  GLANDS  OF  THE  GROIN. — (Holden.) 
Saphenous  opening  of  the  fascia  lata.     2.  Saphena  vein.     3.  Superficial  epigastric  a. 
4.  Superficial  circumflexa  ilii  a.     5.  Superficial  external   pudic  a.     6.  External  ab- 
dominal ring.      7.  Fascia  lata  of  the  thigh. 


136 


THE  ABDOMINAL  WALLS 


Superficial  nerves  (see  Fig.  81):— 

Lower  dorsal. 

Ilio-hypogastric . 

Ilio-inguinal. 
Superficial  lymphatics. 


FIG.  159. — LYMPHATIC  VESSELS  AND  GLANDS  OF  THE  GROIN. — (Holden.} 


THE  ABDOMINAL  WALLS 


137 


Dissect  the  skin  'down  only  one  inch  below  Poupart's  ligament.  Do  not 
go  onto  the  thigh. 

Expose  the  external  abdominal  muscle. 

Carefully  locate  and  study  Poupart's  ligament. 

Locate  and  study  the  external  abdominal  ring,  noting  its  position  and 
its  boundary.  Note  spermatic  cord  or  round  ligament.  Feel  the  opening 
by  pushing  your  finger  up  along  the  spermatic  cord  into  the  ring. 


FIG.  160. — POUPART'S  LIGAMENT,  THE  APONEUROSIS  OF  THE  EXTERNAL  OBLIQUE  AND 
THE  EXTERNAL  ABDOMINAL  RING. — (Holden.) 

i.  External  abdominal  ring.  2.  Its  inferior  or  external  pillar,  curvilinear,  attached  to  the 
spine  of  the  pubis.  3,  3.  Its  superior  or  internal  straight  pillar,  prolonged  to  the 
median  line  attached  to  the  symphysis  pubis,  and  interlacing  with  the  one  of  the  oppo- 
site side.  4,  4.  Ligament  of  Colles,  situated  behind  the  preceding  pillar  and  interlacing 
with  it,  attached  to  the  crest  of  the  pubis  of  the  opposite  side,  thus  forming  an  internal 
pillar.  5,5.  Attachment  of  Colles'  ligament.  6.  Arched  fibers  connecting  the  internal 
and  external  pillars,  forming  the  external  boundary  of  the  ring.  7.  Linea  alba.  8. 
Symphysis  pubis.  Q.  Spermatic  cord.  10.  Poupart's  ligament,  n,  n.  Cribriform 
fascia.  12.  Internal  saphenous  vein. 


331      6 


*/..  i 

12  jA0 


Study  the  external  abdominal  muscle  and  then  detach  it  by  cutting 
it  halfway  between  its  origin  and  the  linea  semilunaris;  turn  it  outward, 
and  inward  to  the  linea  semilunaris.  Do  not  destroy  Poupart's  ligament, 
but  make  an  incision  about  one-half  inch  above  the  lower  border  of  the 
aponeurosis  of  the  external  oblique  and  parallel  with  its  lower  border, 
thus  making  Poupart's  ligament. 

Study  the  internal  oblique  muscle  and  then  detach  this  muscle  the 
same  as  the  external  oblique. 

Observe  the  fibres  of  the  cremaster  muscle,  the  conjoined  tendon  and 
triangular  fascia.  (See  Figs.  161  and  162.) 


138 


THE  ABDOMINAL  WALLS 


FIG.  i6i. — DISSECTION  OF  INGUINAL  CANAL.      (Wood.)     (Morris.) 

,A\ 


Ext.  oblique 
(turned  down) 


Hectus  abdominis 
(with  sheath  opened) 


Int.  oblique 
Transversalis 

Conjoined  tendon 
Triangular  fascia 
Cremaster 


FIG.  162. — DIAGRAM  OF  THE  LOWER  FIBRES  OF  THE  INTERNAL  OBLIQUE  AND  TRANSVERSALIS, 

WITH  THE  CREMASTER  MUSCLE. — (Holden.) 

i.  Conjoined  tendon  of  internal  oblique  and  transversalis.     2.  Cremaster  muscle  passing 

down  in  loops  over  the  cord. 


THE  ABDOMINAL  WALLS  139 

Locate  the  internal  abdominal  ring;  study  its  boundary.     (See  Fig.  16 1 .) 

What  is  the  inguinal  canal? 

Study  the  transversalis  muscle  and  detach  it  same  as  the  oblique 
muscles.  (See  Fig.  161.) 

Observe  the  transversalis  fascia  and  note  that  the  internal  abdominal 
ring  is  bounded  by  this  fascia.  Note  the  spermatic  cord  in  the  male  and 
the  round  ligament  in  the  female  as  they  pass  along  the  inguinal  canal. 

Expose  the  rectus  abdominis  muscle  by  cutting  through  its  sheath 
lengthwise.  Note  the  linea  transversae.  (See  Fig.  163.) 

What  forms  the  sheath  of  rectus  abdominis  muscle? 

Observe  and  study  the  pyramidalis  muscle. 

Study  rectus  abdominis  muscle  and  then  cut  it  across  at  the  um- 
bilicus and  turn  it  upward  and  downward.  Observe  in  the  muscle  above 
the  umbilicus  the  superior  epigastric  artery,  and  in  the  sheath  behind 
the  muscle  below  the  umbilicus  the  deep  epigastric  artery.  Note  the 
relation  of  the  deep  epigastric  to  the  internal  abdominal  ring.  (See  Fig. 

165.) 

Also  observe  the  plica  semilunaris,  or  fold  of  Douglas. 


FIG.    163  — DEEP  MUSCLES   OF  THE  ABDOMINAL  WALL. — (Holden.) 

Rectus  abdominis.  .2,  2.  Internal  oblique.  3,3.  Anterior  leaflet  of  the  aponeurosis  of 
the  internal  obliq.ue.  4,4.  Cut  external  oblique.  5,5.  Spermatic  cord.  6,6.  Inferior 
part  of  the  external  oblique  aponeurosis  turned  back  on  the  thigh.  7.  Rectus  abdom- 
inis; the  upper  part  has  been  excised  to  show  the  aponeurosis  of  the  transversalis.  8,  8. 
Fleshy  portion  of  this  muscle.  9.  Its  aponeurosis.  10  Umbilicus,  n.  Linea  alba 
above  umbilicus.  12.  Infraumbilical  linea  alba  separating  below  the  two  pyramidales. 
13,  13.  Serratus  magnus.  14.  Cut  right  latissimus  dorsi.  15.  Cut  left  latissimus 
dorsi.  16.  Cut  serratus  magnus.  17,  17.  External  intercostals,  18,  18.  Femoral 
aponeurosis.  19.  Cut  internal  oblique. 


140 


THE  ABDOMIXAL  WALLS 


Deep  arteries  of  abdomen:— 

Deep  epigastric  (A.  epigastrica  inferior}. 
Deep  circumflex  iliac. 
Superior  epigastric. 
Intercostalis, — lower. 
Lumbar, — terminal  branches. 


FIG.  164. — SIDE  VIEW  OF  PELVIS  AND  UPPER  THIRD  OF  THIGH,  WITH  THE  EXTERNAL  ILIAC, 
INTERNAL  ILIAC,  AND  FEMORAL  ARTERIES  AND  THEIR  BRANCHES,  LEFT  SIDE. — (Morris.} 
(From  a  dissection  by  W.  J.  Walsham  in  the  Museum  of  St.  Bartholomew's  Hospital.) 
The  bladder  is  hooked  over  to  expose  back  of  pelvis. 


Common  iliac  artery 
SYMPA  THETIC  SER  VE 
Middle  sacral  artery 


Common  iliac  vein 
URETER 

Internal  iliac  artery 
External  iliac  vein 

External  iliac  artery 

Potterior  branch  of  internal  iliac  dividing  into 
gluteal  and  ilio-lumbar  arteries 

Lateral  sacral  artery 

SAGRAL  PLEXUS 
OBTURA  TOR  NER  VE  - 

Obturator  artery 
Obliterated  hypogastric 

Superior  vesical  artery 
Edge  of  levator  ani 

Pudic  artery 

BLADDER 

Middle  vesical  artery 

Deep  epigastric  artery 
Pubic  branch  of  epi- 
gastric artery 
Common  femoral  artery 

Long  snphenoiis  vein 
Peetineus  muacle 

Obturator  artery 

Adductor  maguus 

Internal  circumflex  artery 

Adductor  brevis 

OBTURATOR  NERVE  (ant.  branch) 

Profunda  artery 

Adductor  longus,  hooked  aside 

Superficial  femoral  artery  and  vein 


Graeilis  muscle 
Lower  part  of  sartoriua 


Psoaa  muscie 
Iliu-lumbar  artery 

EXTERSA  7,  f'UTA- 
SEOL'K  SERVE 

Iliacus  muacle 

0  ESI  TO-CRURAL    ,. 
SERVE 

ASTER  I  OR  CRU- 
RAL SERVE 

Deep  circnnifli-jc  iliac 
artery 

Superficial  circumflex 

ilia,-  •• 
A \TKRIOR  CRURAL  N. 

Hint:  <:/.  artery  and 

x»,,,, -I:.,-  ,,l,lt,,,l  „,,;;• 

Tenaor  faciae  femoria 

(hooked  aside) 
Gluteus  medius  and 

minimus 
Sariorius  muscle 
MlhDLI-:  /  CTA-     ' 
SEOUS  SERVE 

SERVE  TO  RECTUS 

KERVE  Til  1M.V/T5 
BXTBSNU8 

Efli'fnnl  cin-ii  in  flex  ar. 

XERVE  TO  CRl'REl'S 

Rectus,  hooked  aside 
I'm ,;,„, la  rein 

L<>.\<;  SAI'llESOUS 
SERVE  AM> 
SERVE  Tit  VAS- 
TUS 


Vastus  internus 
muscle 


THE  ABDOMIXAL  CAVITY 


141 


Study  carefully  the  anatomy  concerned  in  inguinal  hernia.     (See  Figs. 
161  and  165.) 


FIG.  165. — POSTERIOR  PART  OF  LOWER  WALL  OF  ABDOMEN  WITH  THE  DIFFERENT  STRUC- 
TURES ON  IT.     (Blandin.)     (Morris.} 


Deep  epigastric  vessels 
Internal  abdominal  ring 


INNER  BORDER  OF  INGUINAL  CANAL 
\ 


External  iliac  vein 
ILIUM 

VAS  DEFERENS 
CRURAL  CANAL 

Pelvic  fascia 


Obturator  fascia 

Leu 
Hecto-vesi 


Fascia  iliaca 

Obliterated  hypogastrie  artery 


RECTUM 
ISCHIO-RECTAL  FOSSA 


BLADDER 


INTERNAL  PUDIC  VESSELS  AND 
SERVE 


DEMONSTRATION  III. 

ABDOMINAL  CAVITY. 

General  description;   boundaries. 

Open  the  abdomen  by  making  an  incision  through  the  transversalis 
fascia  and  peritoneum,  lying  below  it,  a  little  to  the  left  of  the  median  line 
and  extending  from  the  ensiform  cartilage  to  a  level  of  the  umbilicus. 
From  this  point  make  an  incision  on  each  side  extending  obliquely  outward 
to  the  anterior  superior  spine  of  the  ilium. 

Examine  the  inner  surface  below  the  umbilicus  and  note  :— 

Urachus. 

Hypogastrie  artery — obliterated. 

Fossae. 

(See  Fig.  165.) 


CONTENTS  OF  ABDOMEN. 

Study  the  position  of  each  viscus,  noting  the  relations  to  each  other 
and  to  external  landmarks: — 

Stomach: — Shape,  position  in  abdomen,  and  relation  to  surrounding 
parts. 


142 


THE  ABDOMINAL  VISCERA 


Liver: — Position  in  relation  to  ribs,  stomach,  colon,  and  kidney. 

Large  Intestines: — Relation  to  small  intestines,  liver,  spleen,  kidney, 
and  stomach. 

Small  Intestines: — Duodenum,  jejunum,  ileum,  junction  with  large  in- 
testines. 

Vermiform  Appendix: — Relation  to  caecum. 

Kidney: — Position  as  to  crest  of  ilium,  ribs,  and  vertebras. 

Spleen: — Relation  to  ribs,  colon,  stomach,  and  pancreas. 

Pancreas: — Relation  to  stomach,  duodenum,  and  superior  mesentery 
artery. 


FIG.  166. — THE  VISCERA  AS  SEEN  ON  FULLY  OPENING  THE  ABDOMEN  WITHOUT  DISARRANGE- 
MENT OF  THE  INTERNAL  PARTS.     (After  Sarazin.)      (Morris.) 


DIAPHRAGM 

STOMACH 
SPLEEN 

GREAT  OMENTUM 
SMALL  INTESTINE 


THE  ABDOMINAL  VISCERA 


J43 


FIG.  167. — VIEW  OF  THE  DEEPER  ABDOMINAL  VISCERA.     (Rudinger.)     (Morris.) 


Superior  vena  cava 


THORACIC  DUCT 


Inferior  vena  caret 


ASCENDING  COLON 


Aorta 

LEFT  BRONCHUS 


aSOPHAGUS 


SPLKN 

KIDNEY 
DUODENUM 
DESCENDING  COLON 

SIGMOiD  FLEXURE 
3LADDER 


i44  THE  PERITONEUM 

FIG.  168. — THE  VISCERA  OF  THE  FCETUS.      (Rudinger  )      (Morris.} 


THYROID 


LUNG 


LIVER 
Suspensory  ligament 


SMALL  INTESTINE 


BLADDER 


TRACHEA 


THYMUS 


LUNG 

RIGHT  AURICLE 


RIGHT  VENTRICLE 


STOMACH 


PART  OF  TRANSVERSE 
COLON 


Hypttyastric  artery 


PERITONEUM. 

General  character.  The  following  is  taken  from  Holden's  "  Anatomy  " : 
—"A  certain  range  of  motion  being  necessary  to  the  abdominal  viscera, 
they  are  provided  with  a  serous  membrane,  called  peritoneum.  This  mem- 
brane, like  other  serous  membranes,  is  a  closed  sac,  one  part  of  which  lines 
the  containing  cavity,  the  other  is  reflected  over  the  containing  viscera. 
These  are  respectively  termed  the  parietal  and  the  visceral  layers.  In  the 
female,  however,  it  is  not,  strictly  speaking,  a  closed  sac,  since  it  communi- 
cates with  the  cavity  of  the  uterus  through  the  Fallopian  tubes.  The  in- 
ternal surface  of  the  peritoneum  is  smooth  and  polished,  and  lined  by 
squamous  endothelium;  the  external  surface — the  subperitoneal  tissue- 
is  composed  of  areolar  tissue,  which  connects  the  internal  layer  to  the  in- 
vested viscera  or  abdominal  parietes.  There  is  nothing  between  the  par- 
ietal and  visceral  layers — in  other  words,  inside  the  sac — but  just  sufficient 
moisture  to  lubricate  its  smooth  and  polished  surface.  The  viscera  are 
all,  more  or.  less,  outside  the  sac ;  some  lie  altogether  behind  it,  as  the 


THE  PERITONEUM 


145 


pancreas,  kidneys,  suprarenal  capsule;  others,  as  the  lower  parts  of  the 
duodenum,  caecum,  ascending  and  descending  colon,  are  only  partially 
covered  by  it;  while  others,  as  the  stomach,  liver,  jejunum,  ileum,  and 
some  parts  of  the  large  intestines,  are  completely  invested  by  it;  these 
latter  push  the  visceral  layer  before  them,  and  so  give  rise  to  membranous 
folds;  the  larger  the  fold,  the  freer  is  the  mobility  of  the  viscus  which 
occasions  it." 

To  properly  understand  the  peritoneum  a  knowledge  of  its  formation 
is  necessary.  The  student  should  therefore  study  some  good  description 
of  the  development  of  the  peritoneum. 

Trace  the  peritoneum  vertically. 


FIG.  169. — DIAGRAM  TO  SHOW  THE  PERITONEUM  AS  SEEN  IN  A  VERTICAL  SECTION.      (Allen 

Thomson.)     (Morris.) 


LIVER 


GASTRO-HEPATIC  OMENTUM 
STOMACH 


TRANSVERSE  COLON 
MESENTERY 

SMALL  INTESTINE 


FORAMEN  OF  WINSLOW 
PANCREAS 

DUODENUM 

TRANSVERSE  MESO-COLON 

A  orta 


RECTUM 


BLADDER 


146 


THE  PERITONEUM 


Trace  the  peritoneum  in  transverse  sections  at  different  levels,  using 
the  figures  below  as  guides. 


FIG.  170. — TRANSVERSE  SECTION  OF  THE  PERITONEAL  SAC  AT  ABOUT  THE  LEVEL  OF  THE 

UMBILICUS. — (Morris.) 


FIG.   171. — TRANSVERSE  SECTION  OF  THE  ABDOMEN  AT  THE  LEVEL  OF  THE  FORAMEN  OP 

WINS  LOW. — (Morris.) 


GASTRO-HEPATIC  OMENTUM 


bASTRO-SPLENIC 
OMENTUM 


Greater  sac. 
Lesser  sac. 

Trace  each. 

What  viscera,  and  what  parts  of  what  viscera  are  covered  by  the  greater 
sac ;  what  by  the  lesser  sac  ? 

Where  and  what  is  the  foramen  of  Winslow? 
Great  omentum  (Fig.  175). 

Position. 

Description. 
Lesser  omentum  or  gastro-hepatic. 

Position. 

Description. 
Gastro-splenic  omentum. 

Position. 


THE  PERITONEUM  147 

Gastro-phrenic  ligament. 
Position. 

Phreno-colic  ligament. 
Position. 

Peritoneal  ligaments  connected  with  the  liver,  bladder,  and  uterus  are 
described  with  those  organs. 

There  are  several  pouches  formed  in  the  development  of  the  peritoneum 
which  may  become  the  seat  of  intra -abdominal  herniae.     Locate  these. 

They  are  named  from  their  positions: — 

Fossa  duodeno-jejunalis.     (See  Fig.  172.) 


FIG.  172. — THE  FOSSA  DUODEXO-JEJUXALIS.      (Treves.)     (Morris.) 


THE  FOSSA 


THE  DUODENAL 
FOLD 


—  Inferior  mesenteric 
rein 


Fossa  subcaecalis  or  ileo-caecal. 
Fossa  intersigmoidea. 


148 


THE  MESENTERY  ARTERIES 


Expose  by  cutting  through  the  anterior  layer  of  mesentery  the  follow, 
ing  blood-vessels: — 

Superior  mesentery  artery  and  branches. 


FIG.    173. — THE  SUPERIOR  MESENTERIC  ARTERY  AND  VEIN. — (Morris.) 
(The  colon  is  turned  up,  and  the  small  intestines  are  drawn  over  to  the  left  side.) 


Ileo-colic  artery 


C/ECUM 


VERMIFORM 
APPENDIX 


Left  colic  artery 

Superior  meseji- 
teric  artery  and 
vein 


Vasa  intfstini 
tewiii 


SMALL  INTESTINES 


Superior  mesenteric  vein  and  tributaries. 

Note  the  mesenteric  glands.     (See  Fig.  177.) 

Inferior  mesenteric  artery  and  branches. 

Inferior  mesenteric  vein  and  tributaries.     (See  Fig.  174.) 

Portal  vein  and  tributaries.     (See  Figs.  173,  174,  and  175.) 


THE  MESENTERY  ARTERY 


149 


FIG.  174. — THE  INFERIOR  MESENTERIC  ARTERY  AND  VEIN. — (Morris.') 


Middle  colic  artery 


Inferior  pancreatico- 
diKjdenal  artery 

Xii}ii:rior  meseiitcric 
artery 

Riyht  colic  artery 


Abdominal  aorta 
Vena  cava  inferior 


Riijht  common  iliaf 

artery 

Middle  sacral  artery 
and  vein 


Lffl  colic  artery 

Inferior  mesenteric 
vein 

Inferior  mesenteric 

artery 

Left  colic-  artery 
Inferior  mesenleric 

artery 


Left  common  iliac 
rein 

Sir/moid  artery 


Superior  hiemor- 
rhoidai  artery 


'50 


VEINS  OF  STOMACH 


FIG.  175. — THE  VEINS  OF  THE  STOMACH  AND  THE  PORTAL  VEIN. — (Morris.) 
(From  a  dissection  by  W.  J.  Walsham.) 


Cystic  vein 

Right  branch  of 
portal  vein 

Portal  vein 


Hepatic  arterii 

Continuation  of 

hepatic  artery 

Gastro-diiodenal 

branch  of  hepatic 

artery 

Pyloric  vein 


Right  gaftro- 
epiploic  vein 


Omental  veins 


Left  branch  oj 
portal  rein 


Veins  corre- 
spond ing  lo 
ruxii  brecia 
arteries 

Gastric  artery 

Hepatic  artery 
Splenic  artery 

Gastric  or 
coronary  vein 


Left  ffastro- 
rpip/oic  vein 


ABDOMINAL  VISCERA 


DEMONSTRATION   IV. 
REMOVAL  OF  ABDOMINAL  VISCERA. 

SMALL  INTESTINES:- 

Place  two  ligatures  around  the  jejunum  at  its  beginning  and  cut  be- 
tween the  ligatures.  Similarly  divide  the  ileum  six  inches  above  its  ter- 
mination. Divide  the  mesentery  close  to  the  intestines.  Cut  off  about 
ten  inches  of  the  upper  part  of  the  jejunum  and  the  same  length  of  the 
lower  part  of  the  ileum,  wash  them,  distend  with  air,  and  dry  them.  After 
they  are  dry  cut  them  open  and  study  them. 

.  What  is  the  length  of  jejunum;  length  of  ileum? 

What  is  Meckel's  diverticulum? 

Mesentery — attachments  and  extent. 

Structure  of  intestinal  wall. 

Four  coats — describe  each. 

In  mucous  coat — valvulae  conniventes,  villi,  solitary  glands,  and  Fever's 
patches. 


FIG.  176. — PORTIOX  OF  THE  SMALL  INTESTINE,  LAID  OPEN  TO  SHOW  THE  VALVUL.*  CONNI- 
VE XTES.     (Brinton.)     (Morris.) 


What  is.  the  blood-supply?     (See  Fig.  173.) 
What  is  the  nerve-supply? 
Lymphatics  of  small  intestines. 


ABDOMINAL  VISCERA 
FIG    177. — VESSELS  OF  THE  SMALL  INTESTINE. —  (Morris.) 


Veins 


LARGE  INTESTINES.      • 

Note  the  position  of  the  different  parts  of  the  large  intestines. 

Divide  the  ascending  colon  six  inches  above  the  entrance  of  the  ileum. 
Remove,  wash,  distend  with  air  and  dry  the  caecum.  Then  cut  open  and 
study  caecum, — walls,  ilio-caecal  valve,  opening  of  appendix,  and  appendix. 

FIG.    178. — SECTION  THROUGH  THE  JUNCTION   OF  THE  LARGE   AND  SMALL   INTESTINE  TO 

SHOW  THE  ILEO-C.ECAL  VALVE  AND  APPENDIX  VERMIFORMIS. — (Holden.} 

i.   Ileum.      2.   Caecum  or  caput  coli.     3.  Appendix  Vermiformis. 


Types  of  caecum  (Fig.  179). 

Remove  the  rest  of  the  large  intestines  down  to  the  rectum.  Note 
hepatic,  splenic,  and  sigmoid  flexures. 

Clean,  distend  with  air,  and  dry  part  of  the  ascending  colon  and  sig- 
moid flexure,  then  cut  open  and  study  their  walls,  blood-supply,  and  nerve- 
supply. 


ABDOMIXAL  VISCERA 


FIG.  179. — THE  FOUR  TYPES  OF  CAECUM.      (Treves.)      (Morris.) 
ABC  D 


FIG.  180. — SECTION-  OF  THE  ASCENDING  COLON.     (Allen  Thomson.)     (Morris.} 

Cr?sceTltie  ridge  of  mucous 

membrane  which  divides  the  sacculi  Longitudinal  muscle 


Serous  coat 


Anterior  band 
Mucous  membrane 


Crescentic  ridge  of 
mucous  membrane 


Circular  muscle 


Appendix  epiploica 


Posterior  band 
Mucous  membrane 


Crescentic  ridge  of 
mucous  membrane 


Serous  coat 


Inner  band 


Circular  muscle 


i54  ABDOMINAL  VISCERA 

For  blood-supply  see  Figs.  173  and  174. 

A  close  network  of  tissue  surrounds  the  branches  of  the  abdominal 
aorta.  This  tissue  consists  almost  entirely  of  nerve -plexuses  of  the  sym- 
pathetic system.  The  solar  plexus  is  the  largest  and  surrounds  the  cceliac 
axis. 

Study  the  solar  plexus  and  the  offsets  of  the  solar  plexus. 

Expose  and  study  the  cceliac  axis  and  its  branches.  Xote  especially 
the  branches  going  to  the  stomach.  To  expose  these  pull  down  the  stomach 
and  cut  through  the  peritoneum  above  the  stomach. 


FIG.   181. — THE  CCELIAC  ARTERY  AND  ITS  BRANCHES.— (Morris.} 

Abdominal  aorta  LEFT  CRUS  OF  DIAPHRAGM 

(ESOPHAGEAL  BRANCH 


RIGHT  CRUS  OF  DIAPHRAGM 


Cfgliac  axis 

Gastric  Vasa 

artery  l/revia 


Cystic  artery 

Right  phrenic  artery 

HEPATIC  DUCT 

CYSTIC  DUCT 

Splenic  artery 

COMMON  BILE  DUCT 

Pyloric  artery 

Gastro-dnodenal  artery 


Superior  pancreatico- 
ditodeital  artery 
HEAD  OF  PANCREAS 

Inferior  pancrealico- 

duodenal  artery 

£ight  gastro-epiploic 

'  artery 


Left  gas/ro-ejiiploic  artery 


Pull  the  stomach  down  and  cut  the  oesophagus  just  below  the  dia- 
phragm, and  ligate  and  divide  the  duodenum  at  its  beginning.     Cut  the 
blood-vessels  going  to  the  stomach  and  remove  the  stomach;  clean,  dis- 
tend with  air,  and  dry  it. 
Study  the  stomach:— 

General  description. 

Cardiac  orifice;   cardiac  end,  or  fundus. 

Borders  and  surfaces. 

Relation  to  surrounding  parts. 

Relation  to  peritoneum. 

Alterations  in  position. 

Structures  of  its  wall — four  coats. 


ABDOMIXAL  VISCERA 
FIG.   182. — ANTERIOR  SURFACE  OF  THE  STOMACH. — (Morris.) 

PYLORUS  CARDIAC  ORIFICE 


ANTRUM  PYLORI 


FIG.  183. — MUSCULAR  COAT  OF  THE  STOMACH.  (Luschka.)  (Morris.) 


LONGITUDINAL  LAYER 


CIRCULAR  LAYER 


Blood-supply  of  stomach.     (See  Fig.  181.) 

Nerve-supply — vagus  and  sympathetic. 

Lymphatics. 

Innate  the  duodenum  in  place;  note  its  form,  parts,  and  its  relation 
to  pancreas,  common  bile-duct,  pancreatic  duct,  kidney,  superior  mesen- 
teric  artery  and  vein  (Figs.  184,  185,  186). 

Observe  the  fossa  duodeno-jejunalis.     (See  Fig.  172.) 

Also  study  the  pancreas  in  place  and  its  relation  to  surrounding  struc- 
tures. See  same  figures  as  for  duodenum. 


ABDOMINAL  VISCERA 

FIG.   184. — THE  DUODENUM  FROM  ix  FRONT. — (Morris.) 

SUPERIOR  LAYER  OF  TRANSVERSE  MESO-COLON 


SECOND  PART  OF 
DUODENUM 


FOURTH  PART  OF  DUODENUM 


INFERIOR  LAYER  OF  TRANSVERSE  MESO-COLON 

THIRD  PART  OF  DUODENUM 


SUPERIOR  MESENTERIC  VESSELS 


FIG.   185. — THE  DUODENUM  FROM  BEHIND. — (Morris.)      (Also  see  Fig.  182.) 


Portal  rein 


FOURTH  PART  OF  DUODENUM 


HEAD  OF  PANCREAS 


Next  raise  the  liver  and  expose  the  common  bile-duct,  the  hepatic 
artery,  and  the  portal  vein  by  cutting  through  the  lesser  omentum.  Notice 
their  relative  positions. 

Trace  the  common  bile-duct  down  to  its  entrance  into  duodenum  and 
junction  with  the  pancreatic  duct.  Also  trace  the  common  bile-duct  up 
toward  the  liver  to  where  it  is  formed  by  the  hepatic  ducts;  trace  the 
hepatic  ducts  and  cystic  duct.  Also  trace  the  hepatic  artery  and  portal 
vein  up  to  the  liver.  (See  Figs.  186,  187,  188,  and  189.) 


ABDOMIXAL  VISCERA 


157 


FIG.   186. — DIAGRAM  OF  THE  BRANCHES  OF  THE  CCELIAC  Axis. — (Holden.) 

(Pancreas  in  dotted  outline  behind  the  stomach.) 

i.   Coronaria  ventriculi.      2.   Splenic  a.       3.   Hepatic  a.      4.   Pyloric  a.      5.   Gastro-duode- 
nalis.      6.   Gastro-epiploica  sinistra.      7.  Vasa  brevia.      8.   Superior  mesenteric  a. 


—\--Spleen 


Commencement  of  the  intes- 
tinum  jejunum. 


FIG.  187. — DIAGRAM  OF  THE  VENA  PORT^E  — (Holden.) 
(The  arrow  is  introduced  behind  the  free  border  of  the  lesser  omentum.) 


rv-T«..  SPLENIC. V 

&hs? 


158  ABDOMINAL  VISCERA 

FIG.  188. — RELATION  OF  STRUCTURES  AT  AND  BELOW  THE  TRANSVERSE  FISSURE.     (Thane.) 

(Morris.) 


GALL  BLADDER 


BILE  DUCT 


Portal  rein 


Expose  the  pancreatic  duct  or  canal  of  Wirsung,  and  trace  it^to^its 
junction  with  the  common  bile-duct  or  entrance  into  duodenum. 
Also  trace  duct  of  Santorini. 


FIG.    189. — THE    PANCREAS    AND   ITS   DUCT. — (Morris.} 

DUCT  OF  PANCREAS  DUCT  OF  SANTORINI  COMMON  BILE  DUCT 


DUCT  OF  WIRSUNG 


Now  remove  the  duodenum  and  pancreas. 

Study  the  duodenum, — its  structure,  blood-  and  nerve-supply. 
Study  the  pancreas, — head,  neck,  body,  and  tail,  ducts,  blood-  and 
nerve-supply,  and  lymphatics. 


SPLEEN:— 

Note  its  position,  shape,  surfaces,  borders,  and  supplementary  spleens, 
or  lienculi. 

Trace  splenic  artery  from  cceliac  axis  to  spleen. 

Remove  the  spleen.     Study  its  structure,  size,  and  weight. 

What  is  its  nerve-supply? 

Lymphatics  of  spleen. 


ABDOMIXAL  VISCERA 


159 


DEMONSTRATION   V. 
LIVER  :— 

What  is  its  position  in  relation  to  the  ribs,  stomach,  kidney,  and  colon? 

Peritoneum  and  ligaments. 

Remove  the  liver.     Study  its  borders,   surfaces,   lobes,   fissures  and 
structures.     Describe  the  gall-bladder  or  cyst. 

FIG.  190. — SUPERIOR  SURFACE  OF  THE  LIVER. — (Morris.) 


Site  of  the  Spigelian  lobe 


GALL  BLADDER 


Falciform  or  suspensory  ligament 


FIG..  191. — THE  INFERIOR  SURFACE  OF  THE  LIVER. — (Morris.) 

Vena  cara 


BILE  DUCT 
Portal  vein 
Hepatic  artery 
SPIGELIAN  LOBE 


UMBILICAL  FISSURE 


i6o 


ABDOMINAL  VISCERA 


Trace  the  hepatic  ducts,  portal  vein,  hepatic  artery  into  the  liver.     Note 
hepatic  veins.     How  many  sets  of  capillaries  does  the  liver  have? 

FIG.  192. — POSTERIOR  SURFACE  OF  THE  LIVER. — (Morris.} 

•  Vena  cava 

LEFT  LOBE 


TUBER  OMENTALE 


ATTACHMENT  OF  CASTRO-HEPATIC  OMENTUM 

! 

SPIGELIAN  LOBE 


IMPRESSION  FOR  RIGHT 
SUPRARENAL 


Review  the  hepatic  artery;  the  portal  vein  and  its  tributaries. 


KIDNEY  AND  SUPRARENAL  BODY. 

Expose  the  kidneys  and  suprarenal  bodies  by  removing  the  tissue  in 
front  of  them. 

Study  their  position  and  relations  to  surrounding  parts. 
Study  the  investment  or  capsule  of  kidney. 

FIG.  193. — DIAGRAM  SHOWING  RELATION  OF   KIDNEY  TO  CAPSULE.      (W.   A.)      (Morris.) 


TRANSVERSE  COLON 


DESCENDING  COLON 

PERITONEUM 

FATTY  CAPSULE 

KIDNEY 

PERITONEAL  CAVITY 
Diaphragmatic 


Parietal  muscle 


CUT  EDGE  OF 
PERITONEUM 

Muscular  fibre  in 
subperitoueal 
tissue 

PANCREAS 

Sup.  mesenteric  vein 
DUODENUM 

LYMPHATIC  GLAND 


LUMBAR  VERTEBRA 


SUBPERITONEAL  TISSUE        FATTY  CAPSULE        Renal  vesselt  embedded  In  subperitoneal  tism, 


ABDOMIXAL  VISCERA 


161 


Xote  the  relative  position  of  the  renal  artery,  renal  vein,  and  ureter. 

Remove  one  kidney  with  its  ureter,  cutting  the  ureter  at  the  brim  of 
pelvis.  Do  not  remove  the  other  kidney  at  this  dissection. 

General  description  of  the  kidney,  shape,  size,  hilum,  and  sinus. 

Cut  the  kidney  lengthwise,  as  seen  in  the  figure  below.  Study  the 
parts  exposed  by  the  cut. 


FIG.   194. — LONGITUDINAL  SECTION  OF  THE  KIDNEY  (Tyson,  after  Henle). — (Holden.) 
Cortex,      i".   Labyrinth,      i'.     Medullary    Rays.     2.  Medulla.     2".  Boundary  layer  of 
medulla.     2'.   Papillary  portion  of  medulla.     3.  Transverse  section  of  tubules  in  boun- 
dary  layer.      4.   Fat   of   renal    sinus.      *.   Transversely   coursing   medullary   rays.      5. 
Artery.     C.  Renal  calyx.      U.  Ureter.     A.  Branch  of  renal  artery. 


What  is  the  blood-  and  nerve-supply  of  the  kidney. 
Describe  the  suprarenal  bodies. 


162 


ABDOMINAL  VISCERA 


The  figures  below  show  the  relations  of  some  of  the  abdominal  and 
thoracic  viscera. 


pIG   I9^ — RELATION  OF  THE  ABDOMINAL  VISCERA  TO  THE  PARIETES.     (Treves.)     (Morris.) 


ABDOMINAL  VISCERA 


163 


FIG     196. — ABDOMINAL  VISCERA,   FROM  BEHIND.      (Riidinger.)      (Morris.} 


LARYNX 


DESCENDING   COLON  - 

Inferior  mesenteric 
vein 


Superior  mesenteric 

rein 
ASCENDING  COLON 


1 64  STRUCTURES  ON  POSTERIOR  WALL  OF  ABDOMEN 

DEMONSTRATION  VI. 

STRUCTURES  ON  THE  POSTERIOR  WALL  OF  ABDOMEN. 

Sympathetic  nerves. 

You  will  find  a  close  network  of  tissue  in  front  of  the  abdominal  aorta 
and  around  its  branches.  This  tissue  is  nearly  entirely  sympathetic  nerve 
tissue.  It  is  arranged  in  plexuses,  each  plexus  taking  the  name  of  the 
artery  around  which  it  is  placed.  The  plexus  around  the  cceliac  axis  is 
the  largest  and  is  called  the  solar  plexus. 

The  other  plexuses  are  offsets  of  the  solar  plexus. 

SOLAR  PLEXUS  :- 

Position. 

Semilunar  ganglion. 

Expose  the  ganglia.     Note  their  position,  shape  and  the  connection 
of  the  great  splanchnic  and  small  splanchnic  nerves. 
Study  the  splanchnic  nerves. 
Offsets  of  the  solar  plexus. 

These  take  the  names  of  the  arteries  with  which  they  pass  out  to  the 
viscera. 

Expose  the  gangliated  cord  in  the  abdomen.     (See  Fig.   197.) 
Arteries : — 

Abdominal  arteries. 

Expose  the  abdominal  aorta,  notice  the  position  of  its  branches,  study 
those  with  which  you  are  not  already  familiar. 
Branches  :— 

Phrenic.  Renal. 

Cceliac.  Suprarenal. 

Sup.  mesenteric.  Spermatic. 

Inf.  mesenteric.  Ovarian. 

Lumbar.  Middle  sacral. 

Veins : — 

Inferior  vena  cava  and  tributaries.  Note  the  relation  of  the  veins  to 
the  arteries.  What  difference  between  right  and  left  spermatic  vein? 
(See  Fig.  198.) 

Note  the  beginning  of  the  azygos  veins  by  the  ascending  lumbar  (Fig. 
199). 

Expose  the  receptaculum  chyli, — the  beginning  of  the  thoracic  duct. 
It  lies  behind  the  aorta,  and  between  the  aorta  and  right  crus  of  the 
diaphragm  in  front  of  the  second  lumbar  vertebra  (Fig.  199). 

Study  the  iliac  fascia.     Do  not  remove  it  at  this  time  in  the  dissection. 
Observe  and  study  the  muscles: — 
Psoas. 

Psoasparvus. 
Iliacus. 
Quadratus  lumborum. 


STRUCTURES  ON  POSTERIOR  WALL  OF  ABDOMEX 


165 


FIG.    197. — LUMBAR   PORTION  OF  THE  GANGLIATED  CORD,  WITH  THE  SOLAR  AND  HYPO- 
GASTRIC  PLEXUSES.     (Henle.)     (Morris.} 


GANGLION  DIAPHRA GMA  TICUM 


^UPRARENAL 
CAPSULE 


GREAT  SPLANCH- 
NIC NER  VE 
RIGHT  SEMI  LU- 
NAR   GANGLION 


RENAL  GANGLION 

SMALL  SPLANCHNIC 
NER  VE 

Renal  artery 


GANGLIATED  CORD 


RAMUS  COMMUNICANS 


Hepatic  artery 


BRANCH  TO  A  OR  TIC 
PLEXUS 


LEFT  SEMILV- 
NAR   GANGLION 

GREAT  SPLANCH- 
NIC NERVE 

SMALL  SPLANCH- 
NIC NER  VE 

Superior  mesenteric 
arter;/ 

—  RENAL  GANG  LION 
Renal  artery 


SUPERIOR  MESEKTERIC 
GANGLION- 


BRANCH  TO  AORTIC 
PLEXUS 


GANGLIATED  CORD  OP 
SYMPA  THE  TIC 


Inferior  mesenteric  artery 


INFERIOR  MESEN- 
TERIC GANGLION 


Disc  between  last  lumbar 
and  first  aacral  vertebra 

Common  iliac  vein 
Common  iliac  artery 


i66 


STRUCTURES  ON  POSTERIOR  WALL  OF  ABDOMEN 


FIG.   198. — THE  ABDOMINAL  AORTA  AND  ITS  BRANCHES,  WITH  THE  INFERIOR  VENA  CAVA 

AND  ITS  TRIBUTARIES. — (Morris.) 


Cystic  artery 

HEPATIC  DUCT 

CYSTIC  DUCT 

COMMON  DUCT 

Portal  vein 

Gastro-dnodenal  br. 

Superior  jiyloric  l»: 

Hepatic  artery 

Right  suprarenal  vein 
Inferior  suprarenal 
artery 
Renal  artery 

Renal  vein 

Inferior  vena  cava 
KIDNEY 


Right  spermatic  rein 


Right  spermatic  artery 

Quadratus  lumborum 
muscle 

Right  lumbar  artery  and 
left  lumbar  vein 
Ureteric  branch  of 
spermatic  artery 


Middle  sacral  vessels 


LEFT  LOBE  OF  LIVER 


(ESOPHAGUS 

Left  phrenic  artery 


—  Right  phrenic  artery 


Superior  suprarenal 
Gastric  artery 
Inferior  suprarenal 
Splenic  artery 

Left  phrenic  vein 
Left  suprarenal  vein 
Superior  mesenteric 

artery 
KIDNEY 

Ureter ic  branch  of  renal 
Left  spermatic  vein 


URETER 

Left  spermatic  artery 

Inferior  mesenteric  artery 

Ureteric  branch  of 
spermatic 


Ureteric  branch  of 

common  iliac 
Common  iliac  artery 


External  iliac  artery 
Internal  iliac  artery 


STRUCTURES  OX  POSTERIOR  WALL  OF  ABDOMEN 


167 


FIG.   199. — THE   SUPERIOR   AND    INFERIOR  VEN^  CAV^,  THE    INNOMINATE    VEINS,  AND 

THE  AZYGOS  VEINS. 


Right  common  carotid 

artery 

Right  internal  jugular 
vein 


RIGHT  LYMPHATIC  DUCT 

Innominate  artery 

RIGHT  PXEUMO- 

GASTRIC  SER  VE 

Right  innominate  vein 

Internal  mammary  vein 

Trunk  of  the  pericardiac 
ami  thymic  reins 
Vena  cava  superior 


Vena  azygos  major 


Vena  azygos  minor,  cross- 
ing spine  In  enter  vena 
azygos  major 

Hepatic  veins 


Vena  cava  inferior 

Right  phrenic  artery 
Cieliac  axis 

Right  middle  suprarenal 
artery 


Right  spermatic  artery 
Right  spermatic  vein 


Left  common  carotid 

artery 

LEFT  PXEUMOGAS- 
TRIC  SER  VE 

THORACIC  DUCT 

Left  innominate  vein 

Left  subclavian  artery 


Left  superior  intercostal 
rein 

RECURRENT 
LARYSGEAL 
NERVE 


Vena  azygos  lertiut 

(ESOPHAGUS 

Ijeft  upper  azygos  vein 

fExophageal  branches 
from  aorta 

Vena  mygos  minor 


THORACIC  DUCT 


Left  phrenic  artery 


Left  middle  suprarenal 
artery 

RECEPTACULUM  CHYLI 

Superior  mesenterie 
artery 

Left  ascending  lumbar 

vein 
Left  spermatic  vessels 


Inferior  mesenterie 
artery 


168  STRUCTURES  ON  POSTERIOR  WALL  OF  ABDOMEN 


FIG.  200. — PSOAS,  ILIACUS,  AND  QUADRATUS  LUMBORUM. — (Morris.} 


Quadratus  lutnborum 


Paoas  parvus 


Fsoaa  maguus 


Iliaous 


•transversalis 
anterior 


ratus  lumborum 


LUMBAR  PLEXUS 


169 


LUMBAR  PLEXUS: 

A  plan  of  the  formation  of  the  lumbar  plexus  is  given  in  the  figure 
below. 


FIG.  201. — DIAGRAM  OF  THE  LUMBAR  AND  SACRAL  PLEXUSES.     (Modified  from  Paterson.) 

(Morris.} 


FROM  LAST  THORACIC 


GEX1TO-CRURAL 

ILIV-HYPOGASTRIC 

ILIO-ING  UIXA  L 


EXTERN  A  L 
CUTANEOUS 


OBTURATOR 


ACCESSORY 
OBTURATOR 


BRANCH  TO  ILIACUS 
ANTERIOR  CRURAL 


SUPERIOR  GLUTEAL 
INFERIOR  GLUTEAL 

GREAT  SCIATIC 

NERVE  TO 

QUADRATIC 

FEMUR1H 


EXTERNAL 

POPLITEAL 

SECTION 

INTERNAL 

POPLITEAL 

SECTIO.\ 


FIRST  LUMBAR 


SECOND  LUMBAR 


THIRD  LUMBAR 


FO  UR  TH  L  UMBA  R 


—  FIFTH  LUMBAR 


FIRST  SACRAL 


SECOND  SACRAL 


THIRD  SACRAL 

VISCERAL 
FOURTH  SA CRAL 

PERFORA  TIXG 

CUTANEOUS 
PERIN^EAL 
FIFTH  SACRAL 

JfKRVK  TO  COCCTGEUS 

NER  VE  TO  LE  VA  TOR 
ANI 

FIRST  COCCYGEAL 


TO  HAMSTRINGS       /'      SMALL  SCIATIC 
NERVE  TO  OBTURATOR  INTERNUS 


VISCERAL 


PUDIC 


Expose  the  lumbar  plexus: — 

Genito-crural  (X.  genito-femoralis)  lies  on  the  anterior  surface  of  the 
psoas  muscle.  Trace  it  back  through  the  psoas  muscle  to  its  origin  and 
down  to  its  division. 

Ilio-hypogastric  and  inguinal  pass  in  front  of  the  quadratus  lurn- 
bommjmuscle ;  pick  them  up  here  and  trace  them  back  through  the  psoas 
muscle  to  their  origin. 

External   cutaneous    (X.    cutaneus   fenwris    lateralis]   passes   in   front 


i  yo 


LUMBAR  PLEXUS 


of  the  iliac  muscle  and  behind  iliac  fascia.  Trace  it  back  through  the 
psoas  muscle  to  its  origin  and  out  to  where  it  passes  below  Poupart's  liga- 
ment just  below  the  anterior  superior  spine  of  the  ilium. 

Anterior  crural  (N.  femoralis)  emerges  from  the  outer  border  of  the 
psoas  above  Poupart's  ligament.  Trace  it  through  the  psoas  to  its  origin 
and  down  to  where  it  passes  below  Poupart's  ligament. 

Obturator  emerges  from  the  inner  border  of  the  psoas  at  the  pos- 
terior part  of  the  brim  of  the  pelvis.  Trace  it  back  to  its  origin  and  out 
to  the  obturator  foramen. 

Accessory  obturator,  when  present,  lies  close  to  the  obturator  nerve. 
Trace  it  to  its  origin  and  down  to  where  it  passes  anterior  to  the  brim  of 
the  pelvis. 

Lumbo-sacral  cord  lies  in  front  of  the  ala  of  sacrum.  Trace  it  to  its 
origin  and  to  its  junction  with  sacral  plexus. 

Also  expose  the  last  dorsal  nerve. 


FIG.  202. — BRANCHES  OF  THE  LUMBAR  AND  SACRAL  PLEXUS  VIEWED  FROM  BEFORE.     (After 

Hirschfeld  and  Leveille'.)     (Morris.} 


GANGLIATED  CORD  OF  SYMPATHETIC 
LAST  THORACIC  NERVE 

FIRST  LUMBAR 


ILIO- 

HYPOGASTRIC 
INGUINAL 

SECOND 
LUMBAR 


FOURTH 

LUMBAR 

INGUINAL 

EXTERNAL 

CUTANEOUS 

GEXITO-CRURAL  — 

LUMBO-SACRAL 

CORD 

ANTERIOR  CRURAL  - 
OBTURATOR  — 

GE VITAL  BRAffCB 
OF  GEfilTO'-CRURAL 

CRURAL  BRAXCH  OF 
GE\[TO-CRURAL 

INGUINAL 


DISTRIBU- 
TION OF 
EXTERNAL  ' 
CUTANEOUS 

CRURAL 

BRANCH 

OF  GENITO- 

CRURAL 


AORTIC  PLEXUS 

LAST  THORACIC  NERVE 


ILIO-HYPO- 
GASTRIC 


INGUINAL 

THIRD 
LUMBAR 
NER  VE 


GENITO- 
CRURAL 


EXTERNA  L 
CUTANEOUS 

GENITAL 
BRANCH 
OF 

GENI  TO- 
CRURAL 

CRT HAL 
BRANCH  OF 
QBNITO- 
C RURAL 

OBTU- 
RATOR 


SACRAL 
PLEXUS 


PELVIC  VISCERA 


171 


DEMONSTRATION  VII. 

PELVIC  REGION. 

What  is  the  difference  between  the  male  and  female  pelvis? 

Study  the  positions  and  relations  of  the  pelvic  organs  to  each  other 
and  to  the  surrounding  landmarks.  Remove  none  of  the  viscera. 

Note  in  the  male  pelvis: — 

Bladder: — Position,  form,  relation,  ligaments,  and  the  part  covered  by 
peritoneum. 

Rectum. — Position  arid  the  part  covered  by  peritoneum. 

In  female  pelvis. 

Note  the  bladder  and  rectum. 

Also  uterus. — Position,  ligaments,  and  part  covered  by  peritoneum. 

Fallopian  Tubes. — Position,  relation  to  broad  ligaments. 

Ovaries. — Position,  relation  to  broad  ligaments,  and  Fallopian  tubes. 

Round  Ligaments. — Position,  relation  to  broad  ligaments,  and  attach- 
.ments. 

Trace  the  peritoneum  in  its  course  in  the  pelvis  and  over  the  pelvic 
viscera. 


FIG.    203. — DIAGRAM   OF   THE   RELATIVE   POSITION   OF   THE   PELVIC   VISCERA. — (Holden.) 


Symphysis  pubis. 


Corpus  cavernosum 
penis. 

Glans  penis. 


Corpus  spongiosum 
urethra. 


Bulb  of  corp.  spon- 
giosum. 
Cowper's  gland  with 

duct. 

Membranous  part  of 
urethra  surrounded 
by  compressor 
muscle. 

Prostate  gland. 


Peritoneum       in 
dotted  outline. 


Ureter. 


Vas  deferens. 


Vesicula  senn- 
nalis. 


Expose  the  following  arteries  and  veins: — 
Arteries.     (See  Fig.  164):— 
Common  iliac. 
External  iliac. 

Internal  iliac  (A.  hypogastrica). 
Hypogastric. 

Superior,  middle  and  inferior  vesical. 
Middle  hemorrhoidals. 


Uterine. 
Ovarian. 
Vaginal. 


172 


PELVIC  VISCERA 


FIG.  204. — DIAGRAMMATIC  VERTICAL  SECTION  THROUGH  THE  FEMALE  PELVIC  VISCERA 

(H  olden.} 


Urethra  sur- 
rounded by  its 
compressor 
muscle. 

Vagina. 


Rectum. 


Veins  accompanying  the  arteries. 


FIG.  205. — SCHEME  OP  THE  OVARIAN  AND  UTERINE  AND  VAGINAL  ARTERIES. — (Morris.) 


Branch  Branches  Branch  nMRRiiTcn 

Uterine    to  round            to  to  EXTREMITY  Of 

branch    ligament  isthmus  ampulla  FALLOPIAN  TUBE 

\  l  \ 


Cervical  branch 


Coronal  artery 


Uterine  artery 
Internal  iliac  artery 

Vaginal  arteries 


Azygos  artery  of  rayina 


Review  the  lymphatics  of  the  pelvis  and  abdomen. 
Sympathetic  nerves. 

Hypogastric  plexus. 

Pelvic  plexus. 


THE  PERI  X  ELM 


DEMONSTRATION  VIII. 
PERINEUM. 

Read  a  general  description  of  the  perineum. 

Examine  the  osseous  and  ligamentous  boundaries  of  the  lower  aper- 
ture of  the  pelvis. 

Draw  a  line  from  one  tuberosity  of  the  ischium  to  the  other.  This 
divides  the  aperture  into  an  anterior  or  urethral  region,  and  a  posterior, 
ischio-rectal,  or  anal  region. 

FIG.   206. — DIAGRAM  OF  THE  FRAMEWORK  OF  THE  PERINEUM. — (Holden.) 


Place  the  subject  on  his  back  in  the  perineal  frame;   draw  the  frame, 
with  the  cadaver,  to  the  end  of  the  table. 


FIG.   207. — PERINEAL  FRAME. 


MALE  PERINEUM. 

Pass  a  urethral  sound  along  the  urethra  into  the  bladder, 
prostate  gland  by  inserting  the  finger  into  the  rectum. 


Feel  the 


174 


THE  PERINEUM 


Moderately  distend  the  rectum  with  tow,  and  sew  the  edges  of  the 
anus  together;  raise  the  scrotum  by  means  of  hooks. 

Dissection  of  the  anal  region. 

Make  an  incision  through  the  skin  along  the  line  drawn  from  one 
tuberosity  of  the  ischium  to  the  other,  crossing  in  front  of  the  anus;  a 
second  incision  parallel  to  the  first  across  the  tip  of  the  coccyx;  a  third 
from  the  middle  of  the  first  incision  back,  encircling  the  anus,  to  the  tip 
of  the  coccyx. 

Notice  the  wrinkles  of  the  skin  around  the  anus  caused  by  the  corru- 
gator  cutis  ani  muscle. 


FIG.    208.- 


-MuscLES,    WITH    SUPERFICIAL   VESSELS    AND    NERVES,    OF   THE    PERINEUM. 

(H  olden.) 


Inferior 
pudenda] 


Dissect  the  skin  carefully  away  from  the  anus  so  as  not  to  destroy  the 
external  sphincter  ani  and  turn  it  outward  onto  the  thigh.  Notice  the 
superficial  fascia.  This  fascia  is  common  to  both  anal  and  urethral  re- 
gions of  the  perineum  and  is  continuous  with  similar  structures  in  adjacent 
regions. 

Clean  and  study  the  external  sphincter  muscle.     (See  Fig.  208.) 

On  each  side  of  the  anus  you  see  the  base  of  the  ischio-rectal  fossa 
filled  with  fat. 

The  inferior  hemorrhoidal  arteries  and  nerves  pass  through  this  fat  to 


THE  PERI X RUM  175 

the  rectum.  Remove  the  fat  with  care  so  as  to  preserve  as  many  as  pos- 
sible of  these  hemorrhoidal  arteries  and  nerves. 

At  the  posterior  boundary  of  this  fossa  is  the  gluteus  maximus  muscle ; 
at  the  anterior  boundary  is  the  superficial  transversus  perinei  muscle,  at 
the  inner  side  the  levator  ani  muscle,  outer  side  the  internal  obturator 
muscle.  Expose  these  muscles,  but  do  not  destroy  any  part  of  them. 

Trace  on  the  bony  pelvis  the  internal  pudic  artery  and  pudic  nerve. 

Now  study  the  inferior  hemorrhoidal  arteries  and  hemorrhoidal,  super- 
ficial perineal,  and  fourth  sacral  nerves,  and  hemorrhoidal  veins,- — plexus 
of  veins.  Also  note  the  long  pudendal  nerve  (Fig.  210). 


FIG.  209. — THE  ARTERIES  OF  THE  PERINEUM. — (Morris.) 

On  the  right  side  of  the  perinaeum  (left  side  of  this  figure)  Colles's  fascia  has  been  turned 
back  to  show  the  superficial  vessels.  On  the  left  side  the  superficial  vessels  have  been  cut 
away  with  the  anterior  layer  of  the  triangular  ligament  to  show  the  deep  vessels. 


Superficial  perinceal  vessels 


Colles's  fascia,  turned  back 


Dorsal  artery  of  penis 
Artery  of  crus 


•  Artery  of  bulb 

COWPER'S  GLAND 

Pudic  artery 


Transrerse  perina-n 

Cut  edge  of  triangular 

ligament 
.->  I  TKi: I-'K'f,\  L 

XKRVI-:  (-[VtyiT  OFF 
TIL  1 SS  \  'ERSE  BRA  NCH 
Pudic  vessels 

Inferior  hremorrhoidal  vessels 
anil  nerves 


Dissection  of  the  urethral  region. 

Dissection. — Make  an  incision  from  the  scrotum  along  the  raphe  to 
the  anal  region.  Reflect  the  skin  outward  onto  the  thigh.  Just  beneath 
the  skin  is  the  superficial  fascia  common  to  both  urethral  and  anal  regions 
and  is  continuous  with  similar  structures  in  adjacent  regions. 

Beneath  this  superficial  fascia,  in  the  urethral  region  only,  is  a  layer 
of  fascia  known  as  the  superficial  perineal  fascia,  Colles's  fascia,  or  deep 
layer  of  the  superficial  perineal  fascia.  To  avoid  confusion  we  will  call  it 
Colles's  fascia. 


176 


THE  PERINEUM 


Colles's  fascia  may  be  demonstrated  by  blowing  air  beneath  it  with  a 
blow-pipe.  It  is  attached  on  each  side  to  the  rami  of  the  os  pubis  and 
ischium;  anteriorly  it  is  continuous  with  the  tunic  dartos  of  the  scrotum, 
posteriorly  at  the  base  of  the  urethral  triangle  it  passes  around  the  trans- 
versus  perinei  muscles  and  becomes  continuous  with  the  deep  perineal 
fascia  or  triangular  ligament. 

Remove  Colles's  fascia  and  expose  the  structures  below: — 

Nerves  (see  Figs.  209,  210): — 
Superficial  perineal. 
Inferior  pudendal. 

FIG.   210. — THE  MALE  PERINEUM.      (Modified  from  Hirschfeld  and  Leveille.)     (Morris.} 

BULBO-CAVERNOSUS 

Superficial  triangular  ligament 

ISCHIO-CAVERNOSUS 

Muscles  of  thigh 


INFERIOR  PUDENDAL  NERVE 
SUPERFICIAL  PERINEAL  NERVE 


INFERIOR  HJEMORRHOIDAL  NERVE 
CUTANEOUS  BRANCH  OF  FOURTH  SACRAL 


Arteries  (see  Fig.  209): — 

Superficial  perineal. 

Transverse  perineal. 
Muscles  (see  Fig.  208) : — 

Bulbo-cavernosus. 

Ischio-cavernosus . 

Trans  versus  perinaei. 
What  is  the  tendinous  point? 


Gluteus  masimus 

TUBEROSITY  OF  ISCHIUM 
Great  sacro-sciatic  ligament 
Levutor  ani 
Superficial  transversus  perinaei 


Sphincter  ani 


THE  PERIXEUM 


Xotice  the  arrangement  of  the  fibres  of  bulbo-cavernosus  muscle  in  the 
figure  beloii': — 

FIG.  211. — DIAGRAM  TO  SHOW  THE  ACCELERATOR  URIN.-E  IN  PROFILE. — (Holden.~) 


Corpus  cavemosum. 
Corpus  spongiosum. 

Upper  fibres. 
Middle  fibres. 


Lower  fibres.  . 
Tendinous  centre  of 
perineum. 


Cut  through  the  median  line  of  the  bulbo-cavernosus  muscle  and  turn 
the  fibres  outward  to  expose  the  bulb  of  the  urethra. 

Remove  part  of  the  ischio-cavernosus  muscle  and  observe  the  cms  of 
the  penis. 

The  triangular  ligament  or  deep  perineal  fascia  can  be  seen  in  the 
space  between  the  transversus  perinaei,  ischio-cavernosus,  and  bulbo-cav- 
ernosus muscles.  (See  Figs.  209  and  210.) 

Between  the  fascia  of  Colles  and  the  triangular  ligament  are  the  fol- 
lowing structures: — 
Muscles  :— 

Bulbo-cavernosus. 
I  schio-cavernosus . 
Transversus  perinasi. 
X  erves : — 

Superficial  perinaei. 
Long  pudendal. 
Arteries : — 

Superficial  perinaei. 
Transversus  perinaei. 

The  triangular  ligament  or  deep  perineal  fascia  stretches  across  the 
pubic  arch  from  the  symphysis,  where  it  is  connected  with  the  sub- 
pubic  ligament,  back  to  the  transverse  perineal  muscle,  where  it  joins 
with  Colles 's  fascia.  It  consists  of  two  layers, — superficial,  or  inferior, 
layer,  and  the  deep,  or  superior,  layer.  Remember,  in  describing  the  fascia, 
the  body  is  in  the  upright  position. 

The  superficial  layer  of  the  triangular  ligament  is  attached  ori  the 
sides  to  the  rami  of  the  os  pubis  and  ischium,  anteriorly  to  the  subpubic 
ligament,  as  stated  above,   posteriorly  it  is  connected  with  the  central 
13 


r78 


THE  PERINEUM 


tendinous  point,  and  is  continuous  with  Colles's  fascia,  the  anal  and  ischio- 
rectal  fascia. 

The  deep  layer  of  the  triangular  ligament  is  a  continuation  of  the 
obturator  fascia  across  the  pubic  arch.  The  obturator  fascia  is  attached 
to  the  rami  of  the  pubis  and  ischium  and  then  passes  across  the  pubic 
arch  as  the  deep  triangular  ligament,  joining  the  superficial  layer  of  the 
triangular  ligament  posteriorly. 


FIG.  212. — DIAGRAM  SHOWING  LINES  OF  ATTACHMENT  OF  THE  FASCI/E  AND  MUSCLES  OF 

THE  PELVIS.     (W.  A.)     (Morris.} 


GREATER  SACRO-SCIATIC 
NOTCH 


ISCHIAL  SPINE  WITH  ATTACH- 
MENTS OF  COCCY6EUS  AND 
LEVATOR  ANI 

LESSER  SCIATIC  NOTCH 


Course  of  '  white  line ' 


Obturator  fascia 


Deep  triangular  ligament 

Posterior  border  of 
perinaeal  ledge 

Transversua  perinaei 


Obturator  fascia 


Levator  ani 


SYMPHYSIS 


Subpubic  ligament 

Superficial  triangular 

ligament 
Fascia  of  Colles 

ISCHIO-CAVERNOSUS  AND  CR'JS 


Between  the  superficial  layer  and  deep  layer  of  the  triangular  ligament 
is  a  space  known  as  the  deep  perineal  interspace. 

Remove  the  superficial  layer  of  the  triangular  ligament,  thus  opening 
up  the  deep  perineal  interspace  and  exposing  the  structures  between  the 
two  layers  of  the  triangular  ligament. 

These  structures  are  (see  Figs.  209,  213): — 

Membranous  urethra,  Cowper's  glands,  internal  pudic  artery  and  vein, 
artery  to  bulb  and  cms,  dorsal  nerve  to  penis,  deep  transverse  or  com- 
pressor urethras  (M.  constrictor  urethra),  transverse  perineal,  and  pro- 
fundus  of  Henle  muscles.  Study  each  of  the  above  structures. 

Review  the  internal  pudic  artery  and  branches,  and  pudic  nerve  and 
branches.  What  is  Alcock's  canal? 


THE  PERINEUM 


FIG.   213. — DIAGRAM  TO  SHOW  THE  TRIANGULAR  LIGAMENT  OF  THE   URETHRA  OR  DEEP 

PERINEAL  FASCIA. — (Maiden.) 


Crus  penis. 


Crus  penis 
with  its  artery 
cut  through. 


Tuber  ischii 


i8o 


THE  PERINEUM 


FIG.  214. — DIAGRAM  OF  THE  RELATIONS  OF  THE,  COMPRESSOR  URETHRA  AS  SEEN  FROM 

ABOVE. — (Holden.) 


Catheter.     — • 


Dorsal  nerve  of  the    — 

penis. 
Dorsal  artery  of  the  — 

penis. 
Dorsal  vein  of  the  ~ 

penis. 


Anterior  layer  of  tri- 
angular ligament. 
Ramus  os  pubis 
cut  through. 

Posterior  layer  of  tri- 
angular ligament : 
part  of  the  pelvic 
fascia. 


THE  PERINEUM 


181 


FIG.  215. — SIDE  VIEW  OF  THE  PELVIC  VISCERA. — (Holden.} 

(Taken  from  a  Photograph.) 

External  sphincter.  2.  Internal  sphincter.  3.  Levator  ani  cut  through.  4.  Accele- 
rator urinae.  5.  Membranous  part  of  the  urethra,  surrounded  by  compressor  muscle. 
().  Prostate  gland.  7.  Vesicula  seminalis.  8.  Ureter.  9.  Vas  deferens.  10.  Crus 
penis  divided,  n.  Triangular  ligament.  12.  Superficial  perineal  fascia.  13.  Rec- 
tum. 


FIG.  216. — DEEP  DISSECTION  OF  MALE  PERINEUM.     (Roser.)     (Morris.) 
The  bulb  is  slightly  raised  and  the  rectum  drawn  backwards,  in  order  to  make  clear 
the  membranous  urethra  and  prostate,  which  are  shown  incised  as  in  the  lateral  opera- 
tion of  lithotomy. 


Erector  penis  ^ 


Wilson's  muscle. 

URETHRA  DIVIDED  AS  IN 

THE  LATERAL  INCISION       , 

Artery  to  bulb  (abnormal) * 

PROSTATE  GLAND,  WITH  ITS « 

PLEXUS  OF  VESSELS 
Superficial  perinceal  / 

a  rtrrii 

Levantor  ani,  its       — 
anterior  fibres  raised 
to  show  the  prostate 


Gluteua  maximu... 


ntinuation  of  internal 

piidic  artery 
,  Anterior  layer  of 

triangular  ligament 
-Artery  to  bulb 
• 
I-SJS— COWPER'S  GLAND 


INCISION  IN  THE  PROSTATE 
_.GLAND  AS  IN  THE  LATERAL 

OPERATION 

— Transversus  perinaei 
muscle 


3* — Trunk  of  internal  pudie 
!3f RECTUM 


External  sphincter 


i8a 


THE  PERINEUM 


Locate  and  study  the  following  muscles: — 
Levator  ani.     (See  Figs.  217,  218,  219.) 

Pubo-coccygeus. 

Ilio-coccygeus. 
Coccygeus. 
Obturator  internus. 


FIG.   217. — MUSCLES  OF  THE  FLOOR  OF  THE  PELVIS. — (Morris.) 


SACRUM  ^ 


Pyriformis 


Levator   ani     (divided 
below  the  '  white  line '} 


Space  for  obturator 
interims 


SYMPHYSIS 


rn.txiif/e  for  gluieal 
vessels  and  nerve 

Pyriformis 

Pasxitye  fur  xrialic 
a  inl  11  ml  it'  vessels 
and  nerve 

ISCHIAL  SPINE 


Coceygeus 
Cellular  interval 
Levator  ani 


Capsule  of  prostate, 
and  pubo-prostatic 
ligaments 


FIG.   2 1 8. — DIAGRAM  OF  THE  PELVIC  FASCIA. — (Morris.) 


Transversalis  fascia 


Obturator  fascia 

•  White  line ' 

Hecto-vesieal  fascia 


Obturator  fascia 

Isehio-rectal  fascia 


Alcock'a  canal  with 
pudic  vessels 


Abdominal  muscle* 
ILIAC  CREST 


Psoas 

BORDER  Of  ACETABULUM 


Apex  of  ischio-rectal 
fossa 

Levator  ani 

ISCHIAL  TUBEROSITY 
Sphincter  ani 


PELVIC  FASCIA 


183 


FIG.   219. — MUSCLES  OF  THE  FLOOR  OF  THE  PELVIS.     (W.  A.)      (Morris.) 
(A  portion  of  the  ischial  and  pubic  bones  sawn  away.) 


Aperture  for 

ior  gluteal 
vessels  and  litres 


Aperture  for 
sciatic  anil  pudic 
vessels  and  nerve 


Coecygeal  fibres  of 
levator  ani 


Fibres  of  leva- 
tor  ani 


Sphincter  ani 
RECTUM 


'  White  line '  of 
obturator  fascia 


Pubic  attachment 
of  levator  ani 


PROSTATE 


Tendinous  centre 
of  periuasum 


PELVIC  FASCIA. 

To  expose  the  pelvic  fascia  remove  the  peritoneum.  Note  the  loose 
connective  tissue  between  the  peritoneum  and  fascia  about  the  bladder. 

Study  a  description  of  the  pelvic  fascia.  Notice,  first,  to  what  parts 
of  the  pelvis  the  fascia  is  attached,  and  then,  second,  the  manner  in  which 
it  is  reflected  on  the  pelvic  viscera. 

Trace  the  fascia,  beginning  with  the  iliac  fascia,  with  which  the  pelvic 
fascia  is  continuous,  into  the  pelvis,  notice  its  division  into  recto-vesical, 
obturator,  and  anal,  or  ischio-rectal,  fasciae. 


1 84 


PELVIC  FASCIA 


FIG.   220. — TRANSVERSE  SECTION   OF   THE    PELVIS,   TO   SHOW   THE    REFLECTIONS    OF   THE 
PELVIC  FASCIA.      (After  Gray.)      (H olden.} 


Pelvic  fascia 
dividing. 

Obturator 
fascia  cover- 
ing obturator 
internus. 

Recto-vesical 
layer  cover- 
ing levator 
am. 


Anal  fascia. 


FIG.   221. — VERTICAL  FRONTAL  SECTION  OF  THE  PELVIS,  SHOWING  FASCI/E. — (Morris.} 

(Modified  from  Braune.) 


PROSTATE 
VERUMONTANUM 


Levator  ani 


MEMBRANOUS  URETHRA 

Pudie  vessels 

PUBIC  ARCH 

Fascia  of  ischio- 

cavernosus 

CRUS  PENIS 

BULB 

BULBO-CAVERNOSUS 

WITH  ITS  FASCIA 

Integument  of 

perinaeum 


White  line 


Subperitoneal  fat 

Obturator  internus 

Ischio-reetal  fascia 

OS  INNOMINATUM 

Keeto-vesical  fascia, 
parietal  and  visce- 
ral layers 

Obturator  fascia 

Obturator  mem- 
brane 

ISCHIO-RECTAL  FOSSA 

Deep  triangular  lig, 
Deep  transversus 

perinaei 

Superficial  triangu- 
lar ligament 

Muscles  of  thigh 
Isehio-cavernosus 


Muscles  of  thigh 


FEMALE  PERINEUM 


185 


FEMALE  PERINEUM. 


Follow  the  same  general  order  and  directions  as  those  given  for  the 
dissection  of  the  male  perineum,  noting  the  differences  in  the  organs  and 
the  provisions  made  for  their  accommodations. 
Study  the  external  organs  of  generation: — 
Mons  veneris. 
Vulva. 

Labia  majora. 
Labia  minora. 
Clitoris.    . 
Vestibule. 
Fourchette. 
Glands  of  Bartholin. 
Vagina. 
Hymen. 
Bulbi  vestibuli. 
Study  urethra, — position,  size,  and  plexus  of  veins. 


FIG.   222. — THE  EXTERNAL  GENITALS  OF  THE  FEMALE. — (Morris.} 


MONS  VENERIS   — 


GLANS  CLITORIOIS   % 


MEATUS  URINARIUS  IN 
VESTIBULAR  SPACE 


CORPUS  CL1TORIDIS 


LABIUM  KAJUS 
LABIUM  !;,INUS 


Examine  the  osseous  and  ligamentous  boundaries  of  the  lower  aperture 
of  the  pelvis.     What  difference  exists  between  the  male  and  female  pelvis? 


i86 


PELVIC  VISCERA 


Distend  the  rectum  moderately  with  tow  and  sew  the  edge's  of  the 
anus  together;  also  sew  the  edges  of  the  labia  majora  together. 

Dissection:  Proceed  on  the  same  plan  as  in  the  dissection  of  the 
male  perineum,  following  the  same  directions,  looking  up  the  same  fig- 
ures, noting  the  differences,  where  they  exist. 


FIG.  223. — DIAGRAMMATIC  REPRESENTATION  OF  THE   PERINEAL  STRUCTURES   IN  THE  FE- 
MALE.— (Morris.) 


ISCHIO-PUBIG  ARCH 


CRUS  CLITORIDIS   WITH 
ISCHIO-CAVERNOSUS 


BULBO-CAVERNOSU3 
COVERING  BULBU3 
VESTIBULI 


Superficial  trian- 
gular ligament 


GLANS  CLITORIDIS 
WITH  PREPUCE 

PARS  INTERMEDIALIS 
Mucous  membrane 
of  vestibule 

MEATUS  URINARIUS 


BULBUS  VESTIBULI 


GLAND  OF  BARTHOLIN 


Sphincter  ani 


DEMONSTRATION    IX. 


PELVIC  VISCERA. 


Remove  the  pelvic  viscera. 

Draw  down  the  penis  and  separate  it  from  the  pudic  arch.  Divide  the 
transversus  perinaei  and  levator  ani  close  to  their  insertions,  detach  the 
sphincter  ani  from  its  attachment  to  the  coccyx.  Remove  the  organs 
of  generation,  rectum,  and  bladder  with  the  remaining  kidney  and  ureter 
attached. 

In  the  female  separate  the  clitoris  from  the  pubic  arch;  then  proceed 
the  same  as  in  removing  the  male  organs. 

Dissect  the  rectum  from  the  rest  of  the  organs. 

Rectum: — 

Clean  and  study  the  rectum, — position  and  relation  to  surrounding 
parts,  peritoneum,  recto-vesical  or  recto-vaginal  pouch,  anus,  internal 
sphincter  muscle,  mucous  membrane,  and  rectal  or  Houston's  valves. 


PELVIC  VISCERA 
Describe  the  blood-  and  nerve-supply. 


187 


Male  Reproductive  Organs.— 
Prostate  gland:  - 

Expose  the  prostate  gland  and  vesiculae  seminales  by  following  down 
the  vas  deferens,  dissecting  away  the  tissue  about  the  neck  of  the  bladder 
*  and  the  posterior  inferior  surface  of  the  bladder. 

FIG.  224. — POSTERIOR  VIEW  OF  THE  BLADDER. — (Holden.) 
i.   Ureter.     2.  Vas  deferens.     3.  Vesicula  seminalis.     4.  Trigone.     5.  Prostate. 


FIG.   225. — DIAGRAM  OF  THE  RELATIVE  POSITION  OF  THE  PELVIC  VISCERA. — (Holden.) 


Symphysis  pubis. 


Corpus  cavernosum 
penis. 

Glans  penis. 


Corpus  spongiosum 
urethrse. 


Bulb  of  corp.  spon- 
giosum. 
Cowper's  gland  with 

duct. 

Membranous  part  of 
urethra  surrounded 
by  compressor 
muscle. 

Prostate  gland. 


Peritoneum      in 
dotted  outline. 


Ureter. 


Vas  deferens. 


Vesicula  semi- 
nalis. 


Describe  the  prostate   gland,  vesiculae  seminales,  vas  deferens,   and 
ejaculatory  duct, — position,  function,  blood-  and  nerve-supply  of  each. 


8  PELVIC  VISCERA 

FIG.  226. — VASA  DEFERENTIA  AND  VESICUL^E  SEMINALES.     (After  Sappey.)     (Morris.) 


EJACULATORY  DUCT  - 
SINUS  POCULARIS 


VERUMONTANUM 
ORIFICE  OF  EJACULATORY  DUCT 


AMPULLA  OF  VAS  DEFERENS 


UNION  OF  VESICULA  WITH  VAS 


EJACULATORY  DUCT  ENTERING 
PROSTATIC  FISSURE 


PROSTATE 


MEMBRANOUS  URETHRA 


VAS  DEFERENS 


ORIFICE  OF  SINUS  POCULARIS 
LOWER  END  OF  VERUMONTANUM 


—  VESICULA  SEMINALIS 


FIG.  227. — VAS   DEFERENS   AND   VESICULA   SEMINALIS   DISSECTED.  "  (After  Sappey ) 

(Morris.) 


DIVERTICULA 


DIVERTICULA 


SACCULUS  — 


SACCULI  OF  AMPULLA  OF  VAS 


JUNCTION  OF  VAS  AND  VESICULA 
EJACULATORY  DUCT 


PELVIC  VISCERA 


189 


Testes  and  their  coverings. 

General  description  of  the  testes.     Position  in  foetal  life  and  their 
descent. 

Describe  the  coverings  of  the  testes. 

FIG.   228. — HORIZONTAL  SECTION  OF  THE  SCROTUM  AND  TESTICLE.     (Diagrammatic.) 

(Morris.) 


Skin 

Dartos 

External  spermatic  fascia 

Cre  mast  eric  fascia 

Parietal  layer  of  tunica  vaginalis 


Septum  scroll 


MEDIASTINUM   TESTIS 


Internal  spermatic  fascia  and 
Bubperitoneal  fascia 

Cavity  of  tunica  vaginalis 
Visceral  layer  of  tnnica  vaginahg 
Tunica  albuginea 
Digital  fcssa 


Open  the  scrotum  and  examine  the  testes,  epididymis,  and  the  begin- 
ning of  the  vas  deferens.  Describe  each;  also  describe  the  spermatic 
cord. 

FIG.   229. — DIAGRAM  OF  THE  TESTICULAR  TUBULES. — (Morris.) 


TUNICA  ALBUGINEA  RECEIVING  ATTACH- 
MENT OF  TRABECUL/t 


VAS  RECTUM 


COLLECTING  TUBE 
CONI  VASCULOSI 


VASA  EFFERENTIA 


RETE  TESTIS  IN  MEDIASTINUM  TES1IS 
TUBE  OF  EPIDIDYMIS 


VAS  ABERRANS 
VAS  DEFERENS 


Penis:— 

Root,  body,  and  glans  penis.     Study  each  part.     What  is  the  blood - 
and  nerve-supply? 

Bladder:— 

Insert  a  blow-pipe  through  the  urethra  and  distend  with  air,  and  dry 
the  bladder. 


IQO 


PELVIC  VISCERA 


Study  its  external  surface,  walls,  and  structures,  ligaments,  form 
when  distended  and  when  empty. 

Open  the  bladder  by  making  an  incision  through  the  anterior  wall 
along  the  median  line ;  extend  the  incision  along  the  superior  wall  of  the 
penis,  thus  laying  open  the  bladder  and  urethra. 


FIG.  230. — THE  MALE  URETHRA,  CLEFT  DORSALLY  TO  SHOW  VENTRAL  Mucous  WALL. 

(M orris.) 


URETER -\ 

Plica  uretica 

SECTION  OF  BLADDER 


INTERNAL  URINARY  MEATUS 


PROSTATIC  SINUS  WITH  OPENING  OF 
PROSTATIC   GLANDS 

SINUS  POCULARIS 

FOLLICULAR  GLANDS  OF  DORSAL  WALL 


SEPTUM  PECTINIFORME 


THIN  LAYER  OF  CORPUS  SPONGIOSUM 
ORIFICE  OF  COWPER'S  GLAND 

Albuginea  of  corpora  cavernosa 


SECTION  OF  PROSTATE 
VERUMONTANUM 
EJACULATORY  DUCT 
PROSTATIC  GLANDS 


MEMBRANOUS  URETHRA 


SECTION  OF  CORPUS  CAVERNOSUH 


BULBOUS  PORTION  OF  URETHRA 


Mucous  membrane 


FOSSA  NAVICULARIS 


EXTERNAL  URINARY  MEAVJS; 


PREPUCE 
GLANS  PENIS 


Examine  and  study  the  inner  surface  of  the  bladder. 
What  difference  between  male  and  female  bladder? 


PELVIC  VISCERA 


191 


FIG.   231. — THE  POSTERIOR  WALL  OF  THE  BLADDER.      (After  Henle.)     (Morris.} 


VAS  DEFERENS 


MRETER  PIERCING  VESICAL 
WALL 


PLICA  URETERICA 
VESICAL  APERTURE  OF 
URETER 

MUSCULARIS 

MUCOSA 
JVULA  OF  LIEUTAUD 


PROSTATE 
VERUMONTANUM 
OPENING  OF  EJACULATORY  DUCT 

SINUS  POCULARIS  - 
PROSTATIC  SINUS 


Examine  and  study  the  urethra.     (See  Fig.  230.) 
What  difference  between  male  and  female  urethra? 

Female  reproductive  organs. 

Review  the  external  organs. 
Vagina:— 

Open  the  vagina  by  a  posterior  incision  through  its  wall.      Note  its 
mucous  membrane  and  the  intra-vaginal  cervix.     Describe  the  vagina. 

FIG.  232. — THE  FEMALE  ORGANS  OF  GENERATION.     (Modified  from  Sappey.)     (Morris.} 
(Vagina  divided  and  laid  open  behind.) 


POSTERIOR  SURFACE  OF  BODY  OF  UTERUS 


Utero-ovarian  ligament 
OVARY 

FALLOPIAN  TUBE 

Broad  ligament 


FIMBRIATED  EXTREMITY 

OF  TUBE 
FIMBRIA  OVARICA 

Lower 
part  of  broad  ligament 

OS  UTERI 

OS  EXTERNUM 

VAGINAL  WALL,  DIVIDED  AND  REFLECTED 


VAGINA,  ANTERIOR  WALL 


iQ2  PELVIC  VISCERA 

Uterus: — 

Examine  the  uterus  with  its  broad  ligaments,  Fallopian  tubes,  round 
ligaments  and  ovaries  attached. 

Open  the  uterus  by  a  posterior  median  incision. 
Study  uterus  and  ligaments;    and  ovaries. 


FIG-  233. — FRONTAL  SECTION  OF  THE  VIRGIN  UTERUS.      (After  Sappey.)     (Morris.} 


UTERINE  WALL 
CAVITY  OF  BODY 


UTERINE  WALL 
CAVITY  OF  CERVIX  WITH  ARBOR  VIT/E 


OS  EXTERNUM 
VAGINAL  WALL 


FIG.   234. — THE  BROAD  LIGAMENT  AND  ITS  CONTENTS,  SEEN  FROM  THE  FRONT. — (Morris.) 

(After  Sappey.) 
Also  see  Fig.  232. 


PAROVARIUM 


AMPULLA  OF  FALLOPIAN  TUBE 


FALLOPIAN  TUBE 

EXTERNAL  ANGLE  OF  UTERUS 


FIMBRIATEO  EXTREMITY  OF  TUBE 

FIMBRIA  OVARICA 


Round  ligament 
Ligament  of  ovary 


Anterior  peritoneal  lamina 


What  is  the  blood-  and  nerve-supply  of  the  uterus,  vagina,  ovaries, 
and  broad  ligaments?     (Figs.  205,  235.) 

Study  the  lymphatics  of  the  pelvic  and  abdominal  viscera. 


'93 


FIG.  235. — DIAGRAM  OF   THE  ARTERIES  AND  LYMPHATICS    OF  THE  FEMALE  GENERATIVE 

ORGANS. — (Mcrris.) 


Lymphatics  of  broad  ligament 
(to  lumbar  glands) 


OVARY 


FALLOPIAN  TUBE 


Funicular  lymphatics 
(to  inguinal  glands) 


Uterine  and  vaginal  lymphatics 
(topeli-ic  glands) 


Vnlvar  li/mptiafics 
(to  inguinal  glands) 


Ovarian 
artery  • 


Funicular 
artery 


Vaginal  arteriet 


Transverse  perinceal  artery 


194 


PELVIC  CAVITY 


DEMONSTRATION    X. 

CAVITY  OF  THE  PELVIS. 

Examine  the  pelvis  on  an  articulated  skeleton.     True  pelvis;    false 
pelvis.     Note  the  important  ligaments  of  the  pelvis. 


FIG.  236. — VERTICAL  AXTERO-POSTERIOR  SECTION  OF  THE  PELVIS. — (Morris.} 


Superior  sacro-iliac 
ligament 


Anterior  sacro-iliac 
ligament 

Inferior  sacro-iliac 
ligament 


Small  sacro-sciatio 
ligament 


Great  sacro-sciatic 
ligament 


Review  the  pelvic  fascia. 

Divide  the  body  transversely  in  the  lumbar  region  just  above  the  crest  of 
the  ilium,  and  then  through  the  middle  line  of  the  sacrum  and  symphysis  of 
pub-is. 

»     Now  expose  the  internal  iliac  artery  and  its  branches,  and  internal 
iliac  vein  and  its  tributaries. 


PELVIC  CAVITY  195 

FIG    237. SIDE  VIEW  OF    PELVIS  AND    UPPER.  THIRD  OF  THIGH,  WITH  THE  EXTERNAL 

ILIAC,  INTERNAL  ILIAC,  AND  FEMORAL  ARTERIES  AND  THEIR  BRANCHES,  LEFT  SIDE. 

(From  a  dissection  by  W.  J.  Walsham  in  the  Museum  of  St.  Bartholomew's  Hospital.) 

The  bladder  is  hooked  over  to  expose  back  of  pelvis. 

Common  iliac  artery 
S  YMPA  THETIC  SER  \  ~E 
Middle  sacral  artery 


Common  iliac  vein 
URETER 

Internal  iliac  artery 
External  iliac  vein 

External  iliac  artery 

Potterivr  Iranch  of  internal  iliac  dividing  into 
gluteal  and  ilio-lumbar  arteries 

Lateral  sacral  artery 

SACRAL  PLEXUS 
OBTURATOR  SERVE- 

Obturator  art 
Obliterated  hypogastric 
Superior  vesical  artery 
Edge  of  levator  aiii 

Pudic  artery 

BLADDER 
Middle  vesical  artery 

Deep  epigastric  artery 
Pubic  branch  of  epi- 

artery 
Common  femoral  artery 

Long  sripfienotts  rein  — 
Pectineus  muscle  — 


Obturator  artery 

Adductor  magnus 

Internal  circumflex  artery 

Adductor  brevis 

OBTURA  TOR  SERVE  (ant.  branch) 

Profunda  artery 

Adductor  longus,  hooked  aside 

Superficial  femoral  artery  and  rein 


Gracilis  muscle 
Lower  part  of  sartorius 


Psoas  muscle 
Ilio-lumbar  artery 

EXTERSAL  CUTA- 
SEOUS  SERVE 

Iliacus  muscle 

GESITO-CRURAL 
SER  VE 

ASTERIOR  CRU- 
RAL SERVE 

Deep  circumflex  iliac 

artery 
Superficial  circumflex 

iliac  artery 

ANTERIOR  CRURAL  tf. 
Gluteal  artery  and 


•"•• 


uteali 


Tensor  facias  iemoris 

(hooked  aside) 
Glutens  medius  and 

minimus 
Sartorius  muscle 
MIDDLE  CUTA- 
SEOl'SSERVE 

SERVE  TO  RECTUS 

KERYE  TO  VASTUS 
EXTERXUS 

External  circumflex  ar. 

NERVE  TO  CRUREl'S 
Rectus,  hooked  aside 
Profunda  rein 

LOSfi  SAPHESOUS 
SERVE  AND 
SERVE  TO  VAS- 
TUS ISTERSUX 


Vastus  internus 
muscle 


Fio.   238. — PLAN  OF  THE  BRANCHES  OF  THE  INTERNAL  ILIAC  ARTERY. — (Holden.} 


SAC. MED 


PELVIC  CAVITY 


Sacral  plexus. 

Plan  of  formation  of  pelvic  plexus. 


FIG.  239. — DIAGRAM  OF  THE  LUMBAR  AND  SACRAL  PLEXUSES.     (Modified  from  Paterson.) 

(Mom?.) 


FROM  LAST  THORACIC 


GEN1TO-CRURAL 

ILIO-HYPOGASTRIC 

INGUINAL 


EXTERNAL 
CUTANEOUS 


OBTURATOR 


ACCESSORY 
OBTURA TOR 


BRANCH  TO  ILIAC  US 
ANTERIOR  CRURAL 


SUPERIOR  GLUTEAL 


INFERIOR  GLUTEAL 


GREAT  SCIATIC 

NERVE  TO 

Q.UADRATUS 

FEMORIS 

EXTERNAL 

POPLITEAL 

SECTION 

INTERNA  L 

POPLITEAL 

SECTION 

TO  HAMSTRINGS 


FIRST  LUMBAR 


SECOND  LUMBAR 


THIRD  LUMBAR 


-- FOURTH  L  UMBA  R 


FIFTH  LUMBAR 


FIRST  SACRAL 


SECOND  SACRAL 


THIRD  SACRAL 

VISCERA  L 
FOURTH  SACRAL 

PERFORATING 
CUTANEOUS 


FIFTH  SACRAL 

KERVE  TO  COCCYGEUS 

NER  VETO  LEI  'A  TOR 

ANI 

FIRST  COCCYGEAL 


SMA  LL  SCIA  TIC       PUDIC 
NER  VE  TO  OBTURA  TOR  INTERNUS 


VISCERAL 


PELVIC  CAVITY 


197 


Expose  the  sacral  plexus  by  removing  from  its  anterior  surface  pelvic 
fascia.  The  sciatic  and  internal  pudic  arteries  also  lie  anterior  to  the 
sacral  plexus,  pelvic  fascia  lying  between  the  arteries  and  the  plexus  of 
nerves. 

Trace  the  branches  of  the  sacral  plexus  to  where  they  pass  out  of 
the  pelvis. 


FIG.    240. — BRANCHES  OF  THE  LUMBAR  AND  SACRAL  PLEXUS  VIEWED  FROM  BEFORE. 
(After  Hirschfeld  and  Leveill£.)      (Morris.) 


GANGLIATED  CORD  OF  SYMPATHETIC 
LAST  THORACIC  SERVE 


FIRST  L  UMBAR 


ILIO- 

HYPOGASTRIC 
ING  I" IX A  L 

SECOND 
LUMBAR 


FOURTH 

LUMBAR 

DfQUINAL 

EXTERNAL 

CUTANEOUS 

GKX1TO-CRURAI. 
LU.VBO-SACRAL 

CORD 

ANTERIOR  CRURAL 
OBTURATOR 

GEXITAL  BRAXCB 
OF  GEXITO-CRURAL 

CRURAL  BRA\rrr  OF 

GKXITO- CRURAL 

INGUINAL 

IHXTRIBU-  \ 

TI<>\  /il' 
EXTEHXA  L  1 

CRURAL 
BRANCH 

OF  G  EX  I  TO- 
CRURAL 


AORTIC  PLEXUS 

LAST  THORACIC  NERVE 


ILIO-HYPO- 
GASTRIC 


INGUINAL 

THIRD 
LUMBAR 

XERVE 


GENITO- 
CRURAL 


EXTERNAL 
CUTANEOUS 

GENITAL 
BRANCH 
OF 

GENITO- 
CRURAL 

CRURAL 
BRANCH  OP 
GBK1TO- 
CRURAL 

OBTU- 
RATOR 


SACRAL 
PLEXUS 


Also  expose  the: — 

Fifth  sacral  nerve. 
Coccygeal  nerve. 
Sacro-coccygeal  plexus. 


198 


PELVIC  CAVITY 


FIG.  241. — A  DISSECTION  OF  THE  LUMBAR  AND  SACRAL  PLEXUSES,  FROM  BEHIND. — 

(Morris.} 

(The  anterior  crural  nerve  is  placed  between  the  external  cutaneous  and  obturator  nerves. ) 

Also  see  Fig.  240. 


TWELFTH  RIB 


LAST  THORA  CIC  NER  VE 


ILIO- 
HYPOGASTRIC 


INGUINAL 


ILIAC  BRANCH 

OF  ILIO- 
HYPOGASTRIC 


Glutens  medius 

Gluteal  artery 
SUPERIOR 
GLUTEAL  NERVE 


GREA  T-SCIA  TIC  NER  VE 

INFERIOR  GLUTEAL 
NERVE 

SMA  LL  SCIA  TIC  NER  VE 


Dura  mater  of  cord 


-     POSTERIOR  PRIMARY 
DIVISION 


--  GENITO-CRURAL 


-  CAUDA  EQUINA 


Filura  terminate 


EXTERNAL 
CUTANEOUS 


—  OBTURATOR 

LUMBO-SACRAL  CORD 


*f  ' — FIRST  SACRAL 
NERVE 


FIFTH  SACRAL 
NERVE 


VISCERAL  BHAXCHES 
Sciatic  artery 
Small  sacro-seiatic 

ligament 
PUDIC  NER  VE 

NERVE  TO 

OI1TURA  TOR 
INTERNUS 

PERFORA  TING 
CUTANEOUS  OF 
SECOND      AND 
THIRD  SACRAL 
NERVES 


Sympathetic  nerves:— 

Trace  down  into  the  pelvis  the  gangliated  cord. 
Pelvic  plexus: — 

Offsets  of  the  pelvic  plexus. 
Hemorrhoidal. 
Vesical. 

Prostatic  in  male. 
Vaginal  in  female. 
Uterine  in  female. 
Muscles: 

Examine  the   pyriformis,   coccygeus,    obturator  internus,   and   origin 
of  levator  ani.     (See  Figs.  217,  218.) 

Locate  the  white  line.     (See  Fig.  219.) 


GLUTEAL  REGION 


199 


DEMONSTRATION    XL 

GLUTEAL  REGION. 

Dissection:  Make  an  incision  through  the  skin  from  the  tip  of  the 
coccyx,  carrying  it  obliquely  downward  and  outward  to  the  anterior  side 
of  the  thigh  four  inches  below  the  great  trochanter.  Turn  the. skin  off, 
exposing  the  gluteus  maximus  muscle.  Notice  the  cutaneous  nerves. 


FIG.  242. — DISTRIBUTION    OF   CUTANEOUS    NERVES    ON    THE    POSTERIOR   AND   ANTERIOR 
ASPECTS  OF  THE  INFERIOR  EXTREMITY. — (Morris.} 


LAST 

THORACIC 
ILIO-HYI'O- 
GASTRIC 


SHORT 
SAPHENOU8 


POSTERIOR 
HI!  I  Xf/fKS 
OF  Ll'AfBAR 
XER  VE3 

POSTERIOR 
BRANCHES 
III--  SACRAL 
XER  y£3 

PERFORA  Tiyn 

ctTTAirxous  or 


INGUINAL 


THIRD  SACRAL 


TWIG 
FRolf  IN- 
TERNAL 
CUTA- 
NEOUS 


BRANCHES  OF 
SMALL 
SCI  A  TIC 


INTERNAL 

CUTA- 
OBTCRATOR  NEOUS 


POSTERIOR 
BRAXCB  OP 
IXTERXAL 
CITAXEOL'S 

COMMTXf- 
CAMS 

TIBIALIS 


PA  TELLAR 
BRANCH 
OF  LONG 
S  A  PHE- 
NOL'S 

LONG 
S A  PHE- 
NOL'S 


TWIGS  FROM 
LONG 

a  A  PHENOL'S 


INTERNAL 
CALCANEAN 


ANTERIOR 
TIBIAL 


EXTERNAL 
CUTA- 
NEOUS 


GENITO- 
CRURAL 


MIDDLE 
CUTA- 
NEOUS 


CUTA- 
NEOUS 
BRANCH  OF 
EXTERNAL 
fOPLITEAL 


MUSCULO- 
CUTA- 
NEOUS 

SHORT 

SAPHE- 

KOUS 


Gluteus  maximus  muscle.     (See  Fig.  243.) 

Clean  and  study  the  muscle.  Then  separate  its  border  and  cut  it 
transversely  at  its  origin,  and  as  you  turn  it  down  notice  the  structures 
beneath  and  the  inferior  gluteal  nerve  passing  into  the  muscle.  Cut  this 
nerve  and  turn  the  muscle  dowTi  to  its  insertion. 

Gluteus  medius  muscle  is  now  exposed.     (See  Fig.  246.) 

Study  this  muscle.  Cut  it  vat  its  origin  and  turn  it  down  to  its  inser- 
tion with  care  so  as  not  to  destroy  the  structures  beneath. 


2OO 


GLUTEAL  REGION 


FIG.  243. — THE  GREAT  SCIATIC  NERVE,  WITH  ITS  COLLATERAL  AND  TERMINAL 

BRANCHES. — (Holden.} 


.  Superior  gluteal  nerve. 
.   Inferior  gluteal  or  lesser 

sciatic. 
,  3,  3.  Its  branch   to  the 

gluteus  maximus. 
.  Branch  to  the  pyriformis. 
.  Genital    branch    of   the 

lesser  sciatic. 
.  Femoro-popliteal  of  the 

same  nerve. 
,  7.   Trunk    of    the   great 

sciatic. 

,  g.  Hranch  to  the  long  and 
short  heads  of  the  biceps. 


13.  Branch  to  the  semi- 
tendinosus. 

11.  Branches    to    the 
semi-membranosus. 

12.  Branch  to  the   ad- 
ductor magnus. 
External    popliteal    or 
peroneal. 

Internal  popliteal. 

Filament   to   the   plan- 

taris  muscle. 

16.     Branches    to    the 

j;astrocnemius. 

Origin    of  the    external 

saphenous  nerve. 


FIG.  244. — THE  ARTERIES  OF  THE  GLUTEAL  REGION. — (Holden.} 

i.  Gluteal  artery  and  nerve.  2.  Pudic  artery  and  nerve,  and  nerve  to  obturator  internus. 
3.  Great  sacro-sciatic  nerve.  4.  Sciatic  artery.  5.  Internal  circumflex  artery.  6. 
The  first  perforating  artery. 


GLUTEAL  REGION  201 

Gluteus  minimus  muscle  is  now  exposed.     (See  Fig.  246.) 

Study  this  muscle  in  place;   do  not  remove  it. 

Pyriformis  muscle  is  also  exposed.  Clean  and  study  the  muscle. 
Note  its  relation  to  the  structures  coming  out  through  the  obturator  fora- 
men. Do  not  remove  the  pyriformis  muscle.  (See  Fig.  246.) 

FIG.-  245. — MUSCLE  BENEATH  THE  GLUTEUS  MAXIMUS. — (Holden.) 

i.  Origin  of  gluteus  maximus  divided.  2.  Its  insertion  into  the  oblique  line.  3,  3.  Its 
insertion  into  the  fascia  lata.  4.  Gluteus  medius.  5.  Its  insertion.  6.  Fascia  lata, 
showing  continuity  with  insertion  of  the  gluteus  maximus.  7.  Pyriformis.  8.  Ob- 
turator internus.  9.  Gemellus  superior  or  cephalad.  10.  Gemellus  inferior.  n. 
Quadratus  femoris.  12.  Semi-membranosus.  13.  Biceps.  14.  Adductor  magnus. 
15.  Gracilis.  16.  Vastus  externus. 


LflfflLifdel. 


Nerves  exposed  in  this  region  (see  Figs.  247  and  248)- 
Inferior  gluteal. 
Small  sciatic. 

Great  sciatic  (N.  ischiadicus] . 
Pudic. 
Superior  gluteal  (Fig.  243). 

Arteries  (see  Fig.  246): — 

Gluteal  (a.  glutea  superior). 
Sciatic  (a.  glutecs  inferior}. 
Internal  pudic. 


2O2 


GLUTEAL  REGION 


FIG.  246. — THE  GLUTEAL  REGION,  WITH  THE  GLUTEAL,  SCIATIC,  AND  PUDIC  ARTERIES. — 

(Morris.) 

(From  a  dissection  by  W.  J.  Walsham  in  St.  Bartholomew's  Hospital  Museum.) 

The  inferior  gluteal  branch  of  the  sciatic  artery  has  been  drawn  inwards  over  the  tuber 

ischii  with  the  reflected  origin  of  the  gluteus  maximus  muscle. 

OHuteus  rnedius,  turned  up 


INFERIOR  GLUTEAL  NERVE 

Gluteus  mazimus,  cut 
Internal  circumflex  artery 
Obturator  externus 


Insertion  of  gluteus  medius 


External  circu 


Gluteus  minimus 

Muscular  branches  of  sciatic  artery 
Deep  branch  of  gluteal  artery 

SUPERIOR  GLUTEAL  NERVE 

ted  by  peroneal 
atic  nerve 

of  gluteus  maximus 


Insertion  of 

gluteus  maximus     ' 

First  per/orating  artery 

Qua'dratus  femori 

Branch  of  internal  circumflex  artery 
Obturator  interims  with  the  two  gemelli 


Pudic  artery  and  nerve 
Sciatic  artery 


Semi-tendinosus 
Semi-membrauosus 

LESSER  SCI  A  TIC  NERVE 
A  rteria  comes  nervi  ischiatici. 

POPLITEA  L  FOR  TION  OF  ORE  A  T  SCIA  TIC  NER  VE 
LONG  Pf'DENDAL  NERVE 


PERONEAL  PORTION  OF  GREA  T  SCIA  TIC  NERVE 


GLUTEAL  REGIOX 


203 


FIG.   247. A  DISSECTION  OF  THE  NERVES  IN  THE  GLUTEAL  REGION. — (Morris.} 

(The  g^teus  maximus  and  gluteus  medius  have  been  divided  near  their  insertions,  and 

thrown  upwards.) 


Sciatic  artery 


INTERIOR  GLl'TEAL  XER\'E 
Glutcal  artery 


Gluteus 
medius 


Gluteus  niaximua 


BRANCH  TO  GLl'- 
ft>  MAXIMl'S 


Pl'DIC  SERVE 


Great  sacro-sciatic 
ligament 

[diet 

Come*  nerri  teckia- 
Gemellus 
inferior 


Tensor 

fasciae 

femoris 

XKIIVE   TO 

TKXSftK 

FASCIA 

FEMORIS 


Tendon  of  obturator  externus 


Vastus  ext«rnua 


Gluteus  mazimuB 


Muscles.     Expose  and  study  (see  Fig.  246):— 
Pyriformis. 
Gemellus  superior. 
Gemellus-  inferior. 
Obturator  internus. 
Obturator  externus. 
Study  obturator  membrane. 
Quadratus  femoris. 


204 


GLUTEAL  REGION 


FIG.   248.— DEEP   DISSECTION   OF   THE   GLUTEAL   REGION.     (From   a  preparation   in   the 

Hunterian  Museum.)     (Morris.} 
Also  see  Fig.  245. 


Gluteua  medius 


Gluteus  minimus 

Pyriformis,  divided 

into    two    by   the 

great  sciatic  nerve 

GREAT  TROCHANTER 

Obturator  ezternus 


Quadratus  femori 


Fascial  insertion  of 
gluteus  mazimus 


Horizontal  fibres  of 
adductor  inaguus 


Fleshy  insertion  of 
gluteus  mazimus 


GREAT  SACRO-SCIATIC 
FORAMEN 

GLUTEAL  NERVE 
SUPPLYING  POR- 
TIONX     OF    QLU- 
TE[\S  MEDIfs 
Gluteus  mazimus 


Obturator  internus. 
Below  is  the  infe- 
rior geinellus.  The 
superior  gemellus 
is  absent 


BRANCHES  OF  IN- 
FER ion  JTI>EX- 
DAL  NERVE 


GREA  T  SCIA  TIC  NER  VE. 
Under  it,  oblique  fibres  of 
adductor  magnus  are  seen 


SMALL  SCIA  TIC  NER  VE 


ANTERIOR  FEMORAL  REGION 


205 


DEMONSTRATION    XII. 

ANTERIOR  FEMORAL  REGION. 

Cutaneous  nerves  (Fig.  242). 

Outline  superficial  veins  of  leg  and  thigh  (Fig.  250). 
Superficial  lymphatics  of  leg  and  thigh  (Fig.  250). 
Outline  femoral  artery.     (See  Fig.  257.) 


FIG.  249. — NERVES  ON  THE  ANTERIOR  OR  VENTRAL  PART  OF  THE  THIGH. — (Holden.) 


The  crural. 

Branch  to  the  iliacus. 

Filament  to  the  psoas 
magnus. 

Three  branches  of  the 
crural  to  the  skin, 
divided  to  show  the 
deeper  branches. 

6.  Muscular  filaments 
of  the  superficial  por- 
tion. 

Internal  cutaneous, 
which  pierces  the  fas- 
cia lata. 

Anastomosing  branch 
of  the  internal  cuta- 
neous. 

Branch  to  the  rectus 
femoris. 

Branch  to  the  vastus 
externus. 

1 1 .  Branch  to  the  vas- 
tus intemus. 


-22 


12, 

12.   Internal,  or  long, 

]  t 

saphena  nerve. 

.19 
18 

IS- 

Patellar branch  of  this 

IS 

nerve. 

|17 

M- 

Its vertical  branch. 

13 

'S- 

Obturator  nerve. 

1 

16. 

Its  branch  to  adductor 

: 

longus. 

. 

'7- 

Its  branch  to  the  ad- 

ductor brevis. 

18. 

Its  branch  to  the  gra- 

1 

cilis. 

«9- 

Its  branch  to  the  ad- 

ductor magnus. 
Lumbo-sacral  trunk. 

21. 

Union     of   this  trunk 

and    the    first  sacral 

nerve. 

22, 

22.  Lumbar  and  sacral 

portion  of  the  sympa- 

thetic. 

23- 

External       cutaneous 

nerve  . 

Dissection. — Make  an  incision  through  the  skin  along  the  anterior 
part  of  the  thigh  from  the  middle  of  Poupart's  ligament  to  just  below 
the  patella ;  turn  the  skin  outward  and  inward.  Note  the  structures 
beneath : — 

Superficial  fascia. 
Superficial  nerves.     Tracer- 
Anterior  crural. 

Middle  cutaneous.     (See  Fig.  242.) 
Internal  cutaneous.     (See  Fig.  242.) 


206 


ANTERIOR  FEMORAL  REGION 


FIG.  250. — THE  SUPERFICIAL  VEINS  AND  LYMPHATICS  OF  THE  LEFT  LOWER  LIMB.     (Wai- 
sham.)     (Morris.) 


Supe rficial  ly mphat ics  from 
lateral  wall  of  abdomen 

Superficial  lymphatics  from 
lower  and  anterior  walls 
of  abdomen 


Superficial  epigastric  vein 


Lymphatics  from  penis  and 

scrotum 
Common  femoral  vein 

Superficial  femoral  lymphatic 

glands 
Superficial  external  pudic  vein 


Internal  femoral  cutaneous  vein 


Long  saphenous  vein 


INTERNAL  MALLEOLUS 
Dorsal  venous  arch 


Superficial  inguinal 

lympltatic  (/lands 

Superficial  circumflex 

iliac  vein 


External  femoral 
cutaneous  vein 


.\\JERIOR  FEMORAL  REGIOX 


207 


External  cutaneous.     (See  Fig.  242.) 

Ilio-inguinal. 

Genito-crural.     (See  Fig.  242.) 
Superficial  veins  (see  Fig.  2  50) : — 

Long  saphenous  and  tributaries.     (See  Fig.  250.) 

Trace  the  long  saphenous  vein  up  to  where  it  passes  through  the  saphen- 
ous opening  in*  the  fascia  lata  (Fig.  251). 

Superficial  arteries.     The  origin  from  the  femoral: — 

Superficial  epigastric. 

Superficial  circumflex  iliac. 

Superficial  external  pudic. 


FIG.   251. — SUPERFICIAL  VESSELS  AND  GLANDS  OF  THE  GROIN.     SAPHENOUS  OPENING  WITH 

THE  CRIBRIFORM  FASCIA. — (Holden.) 
i.  Saphenous  opening  of  the  fascia  lata.      2.  Saphena  vein.     3.  Superficial  epigastric  a. 

4.  Superficial  circumflexa  illii  a.     5.  Superficial  pudic  a.     6.  External  abdominal  ring. 

7.  Fascia  lata  of  the  thigh. 


Examine  and  study  the  fascia  lata. 

Expose  saphenous  opening: — 

Position,  how  formed,  relation  of  cribriform  fascia.  (See  Figs.  250 
and  251,  also  252.) 

Locate  Gimbernat's  ligament  (Figs.  252,  253). 

Locate  the  femoral  artery  and  vein  under  Poupart's  ligament.  The 
sheath  of  these  vessels,  called  femoral,  or  crural,  sheath,  is  formed  in  front 
by  a  continuation  of  the  transversalis  fascia,  behind  by  a  continuation 
of  the  iliac  fascia.  These  fascia  meet  close  to  the  femoral  artery  on  the 


208 


ANTERIOR  FEMORAL  REGION 


iliac  side,  but  a  small  space  exists  between  femoral  vein  and  where  they 
meet  on  the  pubic  side;  this  is  the  femoral  or  crural  canal. 

Locate  and  describe  the  femoral  or  crural  canal,  femoral  or  crural 
ring,  septum  crurale. 

What  are  the  coverings  of  femoral  hernias? 


FIG.  252. — DIAGRAM   OF   THE  FEMORAL  RING  AND  THE  SAPHENOUS  OPENING. — (Holden.) 

(The  arrow  is  introduced  into  the  femoral  ring.) 
i.  Crural  arch.     2.  Saphenous  opening  of  the  fascia  lata.     3.  Saphena  vein.     4.  Femoral 

vein.     5.  Gimbernat's   ligament.     6.  External    abdominal   ring.     7.   Position   of   the 

internal  ring  in  dotted  outline. 


FIG.  253. — POSITION  OF  PARTS  UNDER  THE  CRURAL  ARCH  (VERTICAL  SECTION). — (Holden.} 


External  cutaneous  n. 

Iliacus. 

Anterior  crural  n. 
Psoas. 


Crural  arch. 
External  ring. 

\   Femoral  ring. 

T  Femoral  vein  and  artery. 


When  the  obturator  artery  comes  from  the  external  iliac  artery  what 
position  may  it  occupy  in  relation  to  the  femoral  ring?     (Figs.  254,  255.) 
Study  the  anatomy  concerned  in  femoral  hernia. 
Remove  the  fascia  lata  and  expose  the  following  structures: — 
Nerves  (see  Fig.  249): — 


AXTERIOR  FEMORAL  REGION 


209 


Anterior  crural  and  branches.     Trace  the  long  or  internal  saphenous 
down  to  the  knee. 
Scarpa's  triangle. 
Muscles  (see  Fig.  256): — 
Sartorius. 
Tensor  vaginae  femoris. 

Ilio-tibial  band  of  fascia  lata. 


FIG.   254. — IRREGULARITIES  OF  THE  OBTURATOR  ARTERY.     (After  Gray.)     (Morris.) 


Deep  circumflex  iliac  artery 

External  iliac  artery 
External  iliac  vein 

Obturator  foramen. 


/ 


Internal  ring,  with  spermatic 
vessels  cut  short  in  it 

Deep  epigastric  artery 


Lymphatic  gland  in  femoral 
ring 

The  obturator  artery,  given  off 
from  the  external  iliac  tcith  ttie 
deep  epigastric,  descends  to  gain 
the  obturator  foramen,  but  at  a 
safe  distance  from  the  femoral 
ring 


FIG.   255. — IRREGULARITIES  OF  THE  OBTURATOR  ARTERY.     (After  Gray.)     (Morris.) 


n~« 


The  obturator  artery,  coming  off 
from  the  deep  epigastric,  takes 
a  course  -so  near  to  the  femoral 
ring  that  if  would  very  likely 
be  divided  Iry  the  bistoury  intro- 
duced from  irithout  to  divide 
the  base  of  Gimbernafs  liga- 
ment, the  cause  of  the  constric- 
tion 


Quadriceps  extensor. 
Rectus  femoris. 

Vastus  externus  (M.  vastus  lateralis). 
Vastus  internus  (M.  vastus  medialis). 
Crureus  (M.  vastus  intermedialis) . 
Ligamentum  patellae. 

Expose  and  study  these  muscles,  but  do  not  remove  any  of  them. 
15 


2IO 


FIG.  256. — MUSCLES  OF  THE  FRONT  OF  THE  THIGH. —  (Morris.) 


Psoas 


Iliacus 


Pectineus 


Adductor  brevis 


Adductor  longus 


Gravilis 


Adductor  magnus 


Vastus  internus 


Tendon  of  sartorius 


Gluteua  medius 


Gluteus  minimus 
Tensor  vaginae  femoris 


Sartorius 


Rectus  femoris 


Ilio-tibial  band  of  fascia  lata 


—  Vastus  ezternus 


Ligamentum  patellae 


AXTERIOR  FEMORAL  REGION 


211 


Arteries : — 

Common  femoral  and  branches. 
Superficial  femoral  and  branches. 
Deep  femoral  n-ill  be  followed  later. 


FIG.   257. — SIDE  VIEW    OF    PELVIS    AND   UPPER  THIRD  OF  THIGH,  WITH  THE  EXTERNAL 

ILIAC,  INTERNAL  ILIAC.  AND  FEMORAL  ARTERIES  AND  THEIR  BRANCHES.  LEFT  SIDE. 

(From  a  dissection  by  W.  J.  Walsham  in  the  Museum  of  St.  Bartholomew's  Hospital.) 

The  bladder  is  hooked  over  to  expose  back  of  pelvis. 

Common  iliac  artery 
S  YMPA  THETIC  SER I  'E 
Middle  sacral  artery 


Common  iliac  vein 
URETER 

Internal  iliac 
Exlet 

External  Hi 

Potttrior  krone*  of  internal  iliac  dicid 
gluieol  and  ilio-l»ml>ar  arttria 

Lateral  sacral  artery 

SACRAL  PLEXUS 
OBTURA  TOR  SER  VE  - 

Obtu 
OUUermted  hypogoMtrie 

Superior  tttieal  artery 
Edge  of  levator  ani 

Pudic  artery 

una 

Jf iil-.He  retical  artery 

Deep  epigastric  artery 
Pubic  krone*  of  cpi- 

gastric  artery 
Common  femoral  artery 

Long  snphenmis  rtin 
Pectineus  muscle 

Obturator  artery 

Adductor  magnus 

Internal  circumflex  artery 

Adductor  brevia 

OBTURATOR  SERVE  (ant.  branch) 

Profunda  artery 

Adductor  longua,  hooked  aaids 

Superficial  femoral  artery  and  rein 


Gracilia  muscle 
Lower  part  of  sartorius 


Psoas  musc-e 
Ilio-tumbar  artery 


EXTERNAL 
SEOl'S  SERVE 

Iliacus  muscle 

GEXITO-CRURA.L 
SER  VE 

ASTERIOR  CRU- 
RAL SERVE 

Deep  circumflex  iliac 
artery 

Superficial  circumflex 

iliac  artery 

ANTERIOR  CSrSAL  -V. 
Glntfal  artery  and 
mffrior  gluttal  nerre 
Tensor  faciae  femoris 

hooked  aside) 
Gluteus  medius  and 

minimus 

!  —  Sartorius  muscle 
lilliDLE  I  UTA- 
SEOl'S  SERVE 

SERVE  TO  RECTUS 

XERTE  TO  VASTL'S 
EKTEBSVS 

External  circttmflei  ar. 

.VERVE  TO  CarREl'S 

Rectus,  hooked  aside 

Proruada  rein 
LOSG  SAPHESOUS 
SERVE  ASD 
SERVE  TO  VAS- 
TLY ISTERSUS 


Vastus  interuus 
muscle 


ANTERIOR  FEMORAL  REGION 

FIG.  258. — SIDE  VIEW  OF  THE  RIGHT  POPLITEAL  ARTERY. — (Morris.) 
(From  a  dissection  in  the  Hunterian  Museum.) 


Femoral  artery  and  vein 

BRANCHES  OF  THE 
INTERNAL  CUTA- 
NEOUS NERVE 


Apoueurotio  covering 
of  Hunter's  canal 


Anastomotica  magna 
artery 


LONG  SAPHENOUS 
NER  VE 


Vertical  fibers  of  the 
adductor  magnus 

Popliteal  artery 


Vastus  internus  — 
Cut  edge  of  fascia  lata 


BRANCH  OF  SAPHE- 
NOUS NERVE  TO 
P A  TELL  A  R  PLEX- 
US 


SMALL  SCIATIC 
NER  VE 


—  Adductor  rnagnua 


Internal  saphenous  vein 


Part  of  seml- 
tendiuoBua 


Observe  Hunter's  canal. 
Veins : — 

Femoral  and  tributaries. 
Study  the  deep  and  superficial  lymphatics. 


IXTERXAL  FEMORAL  REGION 


213 


INTERNAL  FEMORAL  REGION. 

Dissection. — Remove    the    skin   from    the    internal   femoral    region; 
turn  it  inward,  exposing  the  superficial  fascia  and  nerves. 
Expose  the  following: — 
Muscles  (see  Figs.  256,  257): — 

Gracilis. 

Pectineus. 

Adductor  longus. 

Adductor  magnus. 

Adductor  brevis. 

Iliacus. 

Psoas. 


FIG.   259. — ANTERIOR  CRURAL  AND  OBTURATOR  NERVES.     (Ellis.)     (Morris.) 

Also  see  Fig.  256. 


Femoral  vein 


femoral  artery 


Pectineus 
OBTURATOR  (ANTERIOR  DIV.) 

OBTURATOR  (POSTERIOR 
DIVISION) 


Adductor  longus 


Adductor  brevis 


OBTURA TOR 

(ANTERIOR 

DIVISION) 

Gracilis    — 


Adductor 

GEXICULA  TE 
BRANCH  OF 
OBTURATOR 

Semi-membranosus 


Anastomotica  artery 

PA  TELLAR  BRANCH  OF 
LONG  SAPHENOUS 


Sartorius 
Iliacus 

ANTERIOR  CRURAL 

Fsoaa 

Tensor  vaginae  femoris 

Profunda  artery 

Pectineus 
Kectus  femoria 

LONG  SAPHENOUS 


NERVE  TO  VASTUS 
INTERNUS 


-     Adductor  longus 
•        Femoral  artery 


2I4 


INTERNAL  FEMORAL  REGION 


Arteries: — Trace  the  following: — 
Femoral : — 

Profunda  femoris. 

Branches. 
Muscular. 

Anastomotica  magna. 
Obturator. 


FIG.   260. — PLAN  OF  THE  INOSCULATIONS  of  THE  CIRCUMFLEX  ARTERIES. — (Holden.) 
i.   Crural  Arch.      2.   Internal  iliac.      3.   Superficial  femoral.      4.   Profunda.      5.   Internal  cir- 
cumflex.     6.   External  circumflex.      7.   First  perforating.      8.   Second  ditto.      9.  Third 
ditto.      10.   Gluteal.      u.   Obturator.      12.   Sciatic.      13.   Anastomotica  magna. 


Nerves : — 

Obturator. 
Accessory  obturator. 
Anterior  crural  and  branches. 


(See  Fig.   259.) 


POPLITEAL  SPACE 


215 


DEMONSTRATION    XIII. 

POSTERIOR  FEMORAL  REGION  AND  POPLITEAL  SPACE. 

Popliteal  space. 

The  superficial  structures  of  the  popliteal  space  should  be  dissected 
first  so  as  to  .see  the  relative  position  of  the  parts. 

Dissection. — Make  two  transverse  incisions,  one  three  inches  above 
and  one  three  inches  below  the  knee-joint,  a  third  incision  connecting 
these  two  in  the  median  line.  Turn  the  skin  outward  and  inward. 

Xote  the  superficial  fascia,  cutaneous  branches  of  small  sciatic  nerve, 
internal  cutaneous  and  communicans  fibularis  and  communicans  tibialis 
nerves. 

Remove  the  fascia  and  clean  the  tendons  of  the  outer  hamstring  and 
inner  hamstring,  external  and  internal  popliteal  nerves,  popliteal  vein, 
short  saphenous  vein,  and  popliteal  artery. 


FIG.   261. — LEFT  POPLITEAL  SPACE. — (Holden.) 


Outer  head  of  Gastroc- 

nemius. 


-  Semi  tendinosus. 


Semimembranosus 

Gracilis. 


Sartorius. 


Inner  head  of  gastroc- 
nemius. 


Posterior  femoral  region. 

Dissection. — Make   a   median    incision    along    the    posterior    part    of 
the  thigh  and  turn  the  skin  outward  and  inward.     Note  the: — 
Superficial  nerves  (Fig.  242). 
Small  sciatic. 
External  cutaneous. 
Obturator. 


2l6 


POSTERIOR  FEMORAL  REGION 


FIG.   262. — SUPERFICIAL  MUSCLES  OF  THE  BACK  OF  THE  THIGH  AND  LEG. — (Morris.'} 


Gluteus  tnediuB 


Aponeurosis  of  gluteus  niaximus 


Biceps 


Vastus  externus 


Oastrocnemius 


Peroneus  longua 


I:    iflllf 


Gluteus  maximus 


Semi-membranosue 


Semi-tendinoBua 


Graeilis 

Tendon  of  semi-membranosus 


Flexor  longus  digitorum 


Tendo  AchilliB 


POSTERIOR  FEMORAL  REGION 


21  7 


Muscles  (Fig.  262): — 
Biceps, 

Semitendinosus. 
Semimembranosus. 

Arteries : 

Branches  of  the  profunda. 
Sciatic. 
Xerves : — Deep  branches. 

Great  sciatic  (n.  ischiadiciis] . 
Small  sciatic  (n.  cutanens  posterior}. 
Obturator. 

Deep  parts  of  the  popliteal  space. 
Xerves  (see  Fig.  263): — 
External  popliteal. 
Internal  popliteal. 
Obturator,  articular  branch. 
Arteries : — 

Popliteal  and  branches. 
Anastomosis  about  the  knee-joint. 
Veins : — 

Popliteal  and  tributaries. 


FIG.   263. — DEEP  VIEW  OF  THE  POPLITEAL  SPACE.     (Hirschfeld  and  Leveill6.)       (Morris.) 


Adductor  magnus 

Popliteal  vein 
Popliteal  artery 

INTERNAL  POPLITEAL  NERVE 

Vaatus  internus 

Superior  internal  articular  artery 

Tendon  of  semi-membranosus 
Inner  bead  of  gastroenemius 

Inferior  internal  articular  ar/eri/ 
Poplitfnl  rein 
Popliteua 

Tendon  of  plantaria 


Vaetus  eiternus 

GREA  T  SCI  A  TIC  NERVE 

w-  Short  head  of  biceps 
EXTERNAL  POPLITEAL  NERVE 


Long  head  of  biceps,  cut 
Outer  head  of  gastroenemius 


COMMUNICAJS8  PERONEI  NERVE 


-  Soleus 


Gastroenemius 


External  sapfienous  rein  and  nerve 


2l8 


ARTERIES  ABOUT  THE  KNEE 


FIG.   264. — THE  ANASTOMOSIS  ABOUT  THE  LEFT  KNEE-JOINT.     (Walsham.)     (Motris.) 

(Semi-diagrammatic.) 


Deep  branch  of  anastomolica  magna 

Superficial  branch  of  anastomotica 
magna 


Adductor  magnuB 


Superficial  internal  articular  artery 
piercing  tendon  of  adductor 
magnus 


Internal  lateral  ligament 


Inferior  internal  articular  artery 
passing  under  internal  lateral 
ligament 


Posterior  tibial  artery 


Descending  branch  of  external 
circumflex  artery 


Superior  external  articular  artery 
passing  through  external  inter- 
muscular  septum 


—  EXTERNAL  CONDYLE 


—  Long  external  lateral  ligament 


Inferior  external  articular  artery 
passing  under  external  lateral 
ligament 


Anterior  tibial  recurrent  artery 


Anterior  tibial  artery 


ANTERIOR  TIBIO-FIBULAR  REGIOX  219 

DEMONSTRATION    XIV. 

ANTERIOR  TIBIO-FIBULAR  REGION. 

Examine  the  osseous  parts  of  the  leg,  and  knee-  and  ankle-joints  on 
the  articulated  skeleton. 

Dissection. — Make  an  incision  down  the  anterior  median  line  of 
the  leg  and  dorsum  of  the  foot  to  the  toes,  a  transverse  incision  just  back 
of  the  metatarso-phalangeal  articulation.  Turn  the  skiji  outward  and 
inward.  Make  a  longitudinal  incision  along  the  dorsum  of  each  toe  and 
turn  the  skin  off. 

In  removing  the  skin  from  the  anterior  part  of  the  leg  care  must  be 
used  not  to  destroy  the  musculo-cutaneous,  internal  or  long  saphenous, 
and  external  saphenous  nerves.     (See  Fig.  242.) 
Xote  and  study  the  fascia  of  the  leg. 
Clean  and  study  the  annular  ligament  (Fig.  266). 
Nerves: — Trace  out  the: — 

Long,  or  internal  saphenous. 
External  saphenous.     (See  Fig.  265.) 
External  popliteal. 

Musculo-cutaneous  (X.  peron&us  superficialis).  (See  Fig.  267.) 
Anterior  tibial   (X.  peronozus  projundus}.     (See  Fig.  267.) 
Expose  and  study:— 
Muscles  (see  Fig.  263) : — 
Tibialis  anticus. 

Extensor  proprius  hallucis  (M.  extensor  hallucis  longus}. 
Extensor  longus  digitorum. 
Peroneus  tertius. 
Extensor  brevis  digitorum. 
Dorsal  interossei. 

Arteries: — Expose  and  note  relations: — 
Anterior  tibial  (Figs.  267,  268). 
Posterior  tibial  recurrent. 
Superior  fibular. 
Anterior  tibial-  recurrent. 
Muscular. 
Internal  malleolar. 
External  malleolar. 

Dorsalis  pedis, — continuation  of  anterior  tibial. 
Tarsal. 

Metatarsal  (A.  arcuata)  and  branches. 
Dorsalis  hallucis. 

Communicating  or  plantar  digital. 
Muscles  on  fibular  side: 
Peroneus  longus. 
Peroneus  brevis.     (See  Fig.  266.) 


22O 


ANTERIOR  TIBIO-FIBULAR  REGION 


FIG.  265. — PERONEAL,  EXTERNAL,  OR  LATERAL  POPLITEAL  NERVE. — (Holden.) 
External  popliteal  or  peroneal.  2.  Cutaneous  branch.  3.  Communicans  peronei.  4. 
External  saphena.  5.  Trunk  formed  by  the  union  of  the  external  saphena  with  the 
accessory  of  the  cutaneous.  6.  Calcanean  branch.  7.  Terminal  branch  going  to 
5th  toe.  8.  Terminal  branch  to  4th  and  5th  toes.  9,  9.  Musculo-cutaneous.  10,  10. 
Its  terminal  branches.  1 1 .  Anastomosis  of  the  musculo-cutaneous  with  the  ex- 
ternal saphena.  12.  Anastomosis  of  the  internal  and  external  or  lateral  branches 
of  the  musculo-cutaneous.  13.  Anterior  tibial.  14.  Terminal  branch  of  anterior 
tibial,  supplying  deeper  structure  great  and  index  toes  and  anastomosing  with  the 
musculo-cutaneous. 


ANTERIOR  TIBIO-FIBULAR  REGION 


FIG.  266. — THE  MUSCLES  OF  THE  FRONT  OF  THE  LEG. — (Morris.) 


Ligamentum  patellae 


Gaatrocnemius 


Soleus 


ifiTtensor  proprius  hallucis 


Dorsal  iuterossei 


••;te|v-^;     I 

1     / 


Feroneus  longua 


Tibialia  anticos 


Peroneua  tertiua 


Extensor  longus  digitorum 


Peroneus  tertius 


Extensor  brevis  digitorum 


222 


AXTERIOR  TIBIO-FIBULAR  REGION 


FIG.   267. — BRANCHES  OF  THE  EXTERNAL  POPLITEAL  NERVE. — (Morris.) 
Also  see  Figs.  248  and  265. 


EXTERNAL  POPLITEAL 

NERVE 
RECURRENT  ARTICULAR 


MUSCULO-CUTANEOUS 


BRANCH  TO  PERONEUS 
LONG  US 


BRANCH  TO  EXTENSOR 
L  ONG  US  DIGITOR  UM 

BRANCH  TO  PERONEUS 
BREVIS 


MUSCULO-CUTANEO  US 


MUSCULO-CUTANEO  US 
(OUTER  DIVISION) 


SHORT  SAPHENOUS 


COLLA  TERAL 
BRANCHES  OF  EX- 
TERNAL SAPHENOUS  • 
AND  MUSCULO- 
CUTANEOUS  TO  TOES 


ANTERIOR  TIBIAL 
NER  VE 


Anterior  libial  arte.ru 


Tibialis  anticus 


ANTERIOR  TIBIAL 
NERVE 

MUSCULO-CUTANEOUS 
(INNER  DIVISION) 


ANTERIOR  TIBIAL 
( O  UTER  DJ I 'ISION) 

ITS  DISTRIBUTION  TO 
EXTENSOR  BREVIS 
DIG  I  TO  RUM 

ANTERIOR  TIBIAL 
(INNER  DIVISION) 


\  COLLATERAL 

BRANCHES  OF 
'     MUSCULO-CUTANEOUS 
)      TO  TOES 


AXTERIOR  TIBIO-FIBULAR  REGION 


223 


FIG.  268. — THE  ANTERIOR  TIBIAL  ARTERY,  DORSAL  ARTERY  OF  THE  FOOT,  AND  ANTERIOR 
PERONEAL  ARTERY,  AND  THEIR  BRANCHES,  LEFT  SIDE. — (Morris.} 


Superior  internal  articular  artery 


Inferior  internal  articular  artery 


Anterior  tibial  recurrent  artery 


Anterior  tibial  artery 


Tibialis  anticus  mus 


AXTERIOR  TIBIAL  XERVE 


Extensor  longus  hallucis 


Internal  malleolar  artery 


Anterior  annular  ligament 
Dorsalis  pedis  artery 

Innermost  tendon  of  extensor 
brevis  digitorum 

Communicating  branch 
Dorsalis  hallucis  artery 


Superior  external  articular  artery 


Inferior  external  articular  artery 


Extensor  longus  digitorum 


Extensor  longus  digitorum, 
turned  back 


Peroneus  tertius 


Anterior peroneal  artery 
External  malleolar  artery 

Peroneus  brevis  muscle 

Extensor  brevis  digitorum,  cut 
External  tarsal  branch 
Metatarsal  branch. 
Dorsal  interoueout  artery 


224 


ANTERIOR  TIBIO-FIBULAR  REGION 


FIG.   269. — SCHEME  OF  THE  DISTRIBUTION  AND  ANASTOMOSIS  OF  THE  ARTERIES  OF  THE 

RIGHT  FOOT.     (Walsham.)     (Morris.} 
(The  plantar  arteries  are  shown  in  dotted  outline;    the  dorsal  in  solid  red.) 


Peroneal  artery 


Anterior  peroneal  branch 
External  malleolar  branch 


Posterior  peroneal  artery 


External  tarsal  branch 


External  plantar  artery 
forming  plantar  arch 
Posterior  perforating  branches 


First  digital  artery  to  ou 
side  of  little  toe 


Second,  third,  and  fourth 
dorsal  inlerosseous  arteries 
given  off"  from  melatarsal 
artery 

Second,  third,  and  fourth 
digital  arteries 


Anterior  perforating  branches 


Branch  of  third  dorsal 
inlerosseous  artery  to 
outer  side  of  little  toe 


Anterior  libial  artery 


Internal  malleolar 
branch 


Malleolar  brani-h  of 
posterior  tibial  artery 

Communicating  branch 
between  posterior  tibial 
and  peroneal  arteries 


Internal  plantar  artery 


Internal  tarsal.  branch 


Melalarsal  branch 


—  Communicating  artery 


Dorsalis  fialluci.i  or 
first  dorsal  inter- 
osseous 

Princeps  hallucis  or 
fifth  plantar  digital 
artery 


Dorsal  digital  branch 
of  dorsalis  halliicis 
to  inner  side  of 
great  toe 


POSTERIOR  TIBIO-FIBULAR  REGIOX 


225 


DEMONSTRATION    XV. 

POSTERIOR  TIBIO-FIBULAR  REGION. 

Dissection. — Remove  the  skin  from  the  posterior  tibial  region  with 
care  so  as  not  to  destroy  the  communicans  fibularis  and  tibialis  forming 
the  external  saphenous  nerve.  (See  Fig.  242.)  Note  external  saphenous 
vein. 

When  the  above  superficial  nerves  and  vein  in  the  superficial  fascia 
have  been  traced  and  studied,  clean  and  study  the  gastrocnemius 
muscle;  then  cut  its  two  heads  near  their  origins  and  turn  it  down;  do 
not  remove  it. 

Observe  the  plantaris  muscle. 

FIG.   270. — MUSCLES  OF  THE  CALF. — (Holden.) 


1.  Tendo  Achillis. 

2.  Soleus. 
^j.   Plantaris. 

4.    Its  tendons. 

?.    Popliteus. 
£.   Annular  fibres  of  the  soleus. 

7.    Origin   of  the  inner  head  of 
the  gastrocnemius. 

$-   Same  of  the  outer  head. 
.ft    Tendon  of  the  biceps. 
10,   Tendon  of  the  semi-membra- 

nosus. 
n.   Adductor  magnus. 


12.  Its  tendon. 

13.  Lower   opening   of  Hunter's 

canal. 

14.  External    intermuscular  sep- 

tum. 

15.  Vastus  externus.  • 

16.  Tendon  of   the  flexor  longus 

digitorum. 

17.  Tendon  of  the  peroneus  lon- 

gus. 

18.  Tendon    of     the     peroneus 

brevis. 

19.  Flexor  longus  hallucis. 


Et9 


Study  the  soleus  muscle.  Then  cut  it  at  its  origin  and  the  tendon 
of  the  plantaris  and  turn  them  down. 

In  cutting  the  origin  of  the  soleus  do  not  destroy  any  of  the  struc- 
tures below. 

16 


226 


POSTERIOR  TIBIO-FIBULAR  REGION 


pI(-T    2^j — SUPERFICIAL*  MUSCLES  OF  THE  BACK  OF  THE  THIGH  AND  LEG. — (Morris.) 


Qluteus  mediUB 


Aponeuroais  of  gluteus  mazimua 


Biceps 


Vaatus  externus 


Gaatrocneinma 


8oleu« 


Peroneua  longua 


GluteuB  mazimus 


Seini-tnembrauoaus 


Semi-tendinosu* 


Gracilia 

Tendon  of  aemi-membranoaus 


Sartorius 


Flexor  longus  digitorum 


Tendo  Achillis 


POSTERIOR  TIBIO-FIBULAR  REGION 


227 


Xote  the  tendo  Achillis  (tendo  calcaneus), — its  formation  and  inser- 
tion. Turn  the  tendo  Achillis  down  to  its  insertion,  with  the  gastroc- 
nemius,  soleus,  and  tendon  of  plantaris  attached,  but  do  not  remove  them. 

Note  the  deep  tibial  fascia  and  internal  annular  ligament. 

Trace  down  the  posterior  tibial  artery  and  nerve,  observing  their  rela- 
tion to  each  other  and  to  the  surrounding  muscles. 

FIG.   272. — RELATIONS  OF  THE  POPLITEAL  ARTERY  TO  BOXES  AND  MUSCLES,  LEFT  SIDE. — 

(Morris.) 


Superior  external  articular  artery 

POPLITEAL  SERVE  - 
External  lateral  ligament 
Inferior  external  articular  artery  • 

Popliteus 

Muscular  branch  to  soleus  • 

Soleus  • 

Anterior  tibial  artery 

Peroneus  longus 
Peroneal  artery  . 


BRANCH  OF  POSTERIOR  TIBIAL 
SERVE  TO  FLEXOR  LOSGUS 
HALLUCIS 

Flexor  longus  hallucis 


J 


Superior  internal  articular  artery 

•  Popliteal  arteru 

Posterior  ligament  of  knee 

Azygos  articular  artery 
SEMI-MEMBRANOSUS 

•  Inferior  Internal  articular  artery 

•  Muscular  branch 

•  Tibialis  posticus 
POSTERIOR  TIBIAL  SERVE 


MUSCULAR  BRANCH  OF  POS- 
TERIOR TIBIAL  SERVE  TO 
FLEXOR  LOSGUS  DIG  I TOR  UM 


Flexor  longus  digitorum 


Potlerior  tibial  artery 


Cutaneous  branch  ofperoneal  artery 


Peroneus  bre via  . 
QmtiniMtion  ofperoneal  artery 


Tibialis  posticus 


Communicating  branch 
Internal  annular  ligament 


Internal  calcaneal  artery 


228 


POSTERIOR  TIBIO-EIBULAR  REG/OX 


Study  the  arteries,  muscles,  and  nerves  :- 
Arteries : — 

Posterior  tibial 

Peroneal 

Muscular. 

Medullary. 

Cutaneous 

Communicating. 

Malleolar 

Calcanean 


FIG.   273. — THE  POPLITEAL,  THE  POSTERIOR  TIBIAL,  AND  THE  PERONEAL  ARTERY,  RIGHT 

SIDE. — (Morris.) 


3emi-  tendinosuB 

Semi-meinbranosuB 

Sartorius 

Inferior  internal  articular  artery 

GraciliB 

Inner  head  of  gastrocnemius, 
hooked  aside 

Inferior  sural  artery 


Tibialia  posticus 


Soleus,  turned  back  — 


Posterior  tibial  artery 


Flexor  longus  digitorum 


Tlbialis  posticus 
Flexor  longus  digitorum 

Communicating  artery 


Sn/ierior  external  articular  artery 

Biceps 

Superior  sural  artery 

Popliteal  artery 

Plautaris  muscle 

Fopliteus  muscle 

Inferior  external  articular  artery 

Spot  at  which  anterior  libial  artery 
passes  to  front  of  leg 

Oastrocnemius  and  soleus 


Knf^fj Flexor  longus  hallucis 

|U 

B':'!  'I 

FIBULA 


Anterior  peroneal  artery  passing  to  the 
front  between  the  bones 

Peroneus longus 
Communicating  artery 


POSTERIOR  TIBIO-FIBULAR  REGIOX  229 

FIG.  274. — ANASTOMOSES  OF  TIBIAL  ARTERIES.— (Morris.)     (Also  see  Fig.  272  ) 


Anterior  tibial  recurrent  — V 


Posterior  tibia/,  giving  off  muscular  and 
medullary  branches 


TIBIA 


Popliteal 

Anterior  tibial,  giving  off  posterior  tibia', 
recurrent    and   superior   fibulnr    before  ( 
piercing    interosseous     membrane     and 
anterior  tibial  afterwards 


FIBULA 


Peroneal 


Anastomosis  of  internal  malleolar  of  anterior  . 
tibial  u'itfi  posterior  internal  malleular 


Internal  calcanean 
Internal  and  external  plantar 


A  nterior  peroneal 

Posterior  peroneal 


External  malleolar  oj  anterior  tibial  joining 
posterior  peroneal 


ASTRAGALUS 
External  calcanean 

CALCANEUM 


Nerves : — 

Posterior  tibial  (n.  tibialis]  and  branches.     (See  Fig.  272.) 
Muscles : — 

Popliteus. 

Flexor  longus  hallucis. 

Flexor  longus  digitorum. 

Tibialis  posticus. 


230 


POSTERIOR  TIBIO-FIBULAR  REGION 


FIG.  275. — THE  DEEP  MUSCLES  OF  THE  BACK  OF  THE  LEG. — (Morris.') 


Outer  head  of  gastrocnemius 


Inner  head  of  gastrocuemius 


Biceps 


Tendon  of  semi-membranosua 


•  Popliteus 


Peroneua  longua  • 


Flexor  longus  hallucis  • 


Tibialis  postieus 


Flexor  longus  digitorum 


Peroneua  brevis  . 


Tibialia  posticus 


Teudo  Aohillis 


THE  FOOT 


231 


PLANTAR  REGION  OF  THE  FOOT. 

Remove  the  skin  from  the  plantar  surface  of  the  foot  and  toes. 
Note  the  plantar  fascia, — position  and  density,  describe  it.     Cut    it 
near  the  heel  and  turn  it  forward,  exposing  the  first  layer  of  muscles  of 
the  sole  of  the  foot  and  branches  of  arteries  and  nerves. 
Muscles, — First  layer. 

Flexor  brevis  digitorum  pedis. 

Abductor  hallucis. 

Abductor  minimi  digiti  pedis. 


FIG.  276. — THE  PLANTAR  ARTERIES,  LEFT  FOOT. — (Morris.') 
(From  a  dissection  in  the  Museum  of  St.  Bartholomew's  Hospital.) 


External  calcanean  artery 
Cutaneous  branch  of  external  plantar 

Abductor  minimi  digiti 

Anastomotic  branch 
External  plantar  artery 


First  digital  to  outer  side  of 
little  toe 
Lumbrical  muscle 

Second  digital 
Third  digital 
Fourth  digital 


Anastomosis  about  inler- 

phalangeal  joint 
Dorsal  branch  of  collateral 
digital 


Anastomosis  of  collateral  digital 
arteries  around  matrix  of  nail 
and  pulp  of  toe 


Internal  calcanean  artery 


Cutaneous  branch  of  internal 
plantar 


Plantar  fascia,  cut 


Abductor  hallucis 


Internal  plantar  artery 


Flexor  brevis  digitorum 


Branch  of  internal  plantar  to 
digital  arteries  (superficial 
digital) 

Flexor  brevis  hallucis 


Princeps  hallucis,  or  fifth  plantar 
digital  artery 


Collateral  digital  branch  ofprincept 

hallucis  to  second  toe 
Collateral  digital  branch  ofprincep* 

hallucis  to  inner  side  of  great  toe 
Collateral  digital  branch  ofprincept 
hallucis  to  outer  side  of  great  toe 


232 


THE  FOOT 


Nerves  :— 

Internal  plantar  (n.  plantaris  medialis)  and  branches. 
External  plantar  (n.  plantaris  lateral-is}  and  branches. 


FIG.  277. — SUPERFICIAL  NERVES  IN  THE  SOLE  OF  THE  FOOT.     (Ellis.)      (Morris.) 


Abductor  hallucis 


Flexor  brevis  digitorum 

INTERNAL  PLANTAR 

NERVE 
Internal  plantar  artery 


BRANCH  OF  INTER- 
NAL PLANTAR 
NERVE  TO  INNER 
SIDE  OF  HALLUX 


Abductor  minimi  diiti 


External  plantar  artery 

EXTERNAL  PLANTAR 
NERVE 


DIGITAL  COLLATERAL 
BRANCHES  OF  EX- 
TERNAL PLANTAR 


DIGITAL  COLLATKRA1, 
BRANCHES  OF  IN'l  AA'- 
NAL  PLANTAR 


Arteries : — 

Internal  plantar  (a.  plantaris  medialis}  and  branches. 

External  plantar  (a.  plantaris  lateralis]  and  branches. 
Use  great  care  and  do  not  cut  the  digital  branches  of  nerves  and  arteries. 
Remove  the  first  layer  of  muscles  and  expose: — 
Arteries : — 
Deeper  parts  of  the  external  and  internal  plantar  and  branches. 


THE  FOOT 


233 


FIG.   278. — RIGHT  PLANTAR  ARTERIES  (DEEP). — (Morris.) 
(From  a  dissection  in  the  Hunterian  Museum.) 


Internal  calcanean  branch 
of  posterior  tibial 


Posterior  tibial  artery 


Abductor  hallucis,  out 


Internal  plantar  artery 


Inner  head  of  flexor 
accessor! UB 


Flexor  longua  hallucia 

External  plantar  artery 

Adductor  hallucis 

Flexor  brevis  hallucis 


Princeps  hallucis  artery 

Flexor  tendons, 

cut  short 

Collateral  digital  branch  of 

princeps  hallucis  to  inner 
tide  of  great  toe 


Cutaneous  and  anastomolic 
branches  of  external 
plantar 

Outer  head  of  flexor 
accessor!  ua 


Abnormal  muscular  slip 
Muscular  branch 
Cutaneous  branch 

Collateral  digital  artery  to 
outer  side  of  little  toe 

Second  digital  artery 
Third  digital  artery 
Fourth  digital  artery 


FIG.  279. — (Holden.) 
i.   Internal  plantar  artery.     2.  External  plantar  artery. 


234 


THE  FOOT 

Nerves : — 

Deeper  parts  of  internal  and  external  plantar  and  branches. 


FIG.  280. — MUSCLES,  VESSELS,  AND  NERVES  OF  THE  SOLE  OF  THE  RIGHT  FOOT,  AFTER 
REFLECTION  OF  THE  FLEXOR  BREVIS  DIGITORUM. — (Holden.) 

i.  Abductor  minimi  digiti.  2.  Flexor  Accessorius.  3.  Abductor  hallucis.  4.  External 
plantar  artery  and  nerve.  5.  Tendon  of  flexor  longus  hallucis.  6,  7.  Internal  plan- 
tar artery  and  nerve.  8.  Flexor  brevis  minimi  digiti.  9.  Lumbricales.  10.  Inter- 
nal plantar  nerve,  n.  Tendons  of  the  flexor  brevis  digitorum  bifurcating  for  the 
passage  of  the  tendons  of  the  flexor  longus  digitorum. 


THE  FOOT 


235 


Muscles  below  the  first  layer  of  muscles  :— 
Flexor  accessories. 
Lumbricales. 

Tendon  of  flexor  longus  digitorum. 
Tendon  of  flexor  longus  hallucis. 
Flexor  brevis  hallucis. 
Flexor  brevis  minimi  digiti. 
Adductor  hallucis. 
Transversus  pedis. 
Plantar  interossei. 


FIG.  281. — SECOND  LAYER  OF  THE  MUSCLES  OF  THE  SOLE. — (Morris.*) 


Jrigin  of  abductor  minimi  digiti 


Part  of  abductor  minimi  digiti    


Flexor  brevis  minimi  digit 


Abductor  minimi  digiti 
Lumbrical's 


Tendon  of  flexor  brevis 

digitorum 


Tendon  of  flexor  brevis  digitorum 


Flexor  brevi:  digitorum 


Abductor  hallueis 


Accessorius 


Flexor  longus  digitorum 


Plexor  longus  hallucis 
Flexor  brevis  hallucis 

Adductor  hallucis 
Abductor  hallucis 


236 


THE  FOOT 


FIG.  282. — VIEW  OF  THE  THIRD  LAYER  OF  MUSCLES  OF  THE  FOOT. — (Holden.) 
a.  Abductor  hallucis.     b.  Flexor  brevis  digitorum.     c.  Abductor  minimi  digiti.     d.  Ten- 
don of  peroneus  longus.     e,  n.   Flexor_longus  hallucis.     /.  Tendon  of  flexor  longus 


digitorum.     £.   Flexor  accessorius. 
lucis.     k.  Flexor  brevis  hallucis.     /. 
posticus. 


Flexor  brevis  minimi  digiti.     i.  Adductor  hal- 
Interossei.      m.  Transversalis  pedis.     o.  Tibialis 


a 


THE  FOOT 


237 


Examine  the  relations  of  the  structures  behind  the  inner  malleolus 
and  above  the  ankle-joint. 

FIG.   285. — RELATIONS  OF   PARTS   BEHIND  THE   INNER   MALLEOLUS.     (Heath.)     (Morris.} 

/Tendo  Aehillis 


Tibialis  postieus 


Tibialis 

Tibialis  anticus 


postieus 


Flexor  longus  digitortun 

Interior  tibia!  artery 
POSTERIOR  TIBJUL  A'E£  VE 


Flexor  longus  digitomm 


FIG.  284. — TRANSVERSE    SECTION  THROUGH   THE   LOWER  THIRD  OF   THE    LEFT   LEG, 

IMMEDIATELY    ABOVE    THE    ANKLE-JOINT.        (Braune.)        ( 


Extensor  longus  digitorum 


Peroneus  longus 

Peroneus  brevis 

Flexor  longus  hallucis 

EXTERNAL  Cl'TAXEOL'S  XESl'E 


Tibialia  anticus 

Extensor  proprius  hallucis 


Tibialis  postieus 
Flexor  longua  difitoram 


When  the  dissection  of  the  lower  extremity  is  completed  place  the  parts 
in  their  proper  position  and  study  the  relative  position  each  part  has  to 
its  surroundings. 


238          ANASTOMOSES  OF  ARTERIES  OF  LOWER  EXTREMITY 
Examine  the  anastomoses  of  the  arteries  of  the  lower  extremity. 


FIG.  285. — To  SHOW  THE  ANASTOMOSES  OF  THE  ARTERIES  OF  THE  LOWER  EXTREMITY. 
(After  Smith  and  Walsham.)     (Morris.) 


Deep  epigastric  artery 
Ilio-luHtbar  artery 

Deep  circumflex  iliac  artery 
Gluteal  artery . 

Common  femoral  artery  • 

Profunda  artery  • 

External  cimimflex  artery 

Crucial  anastomosis 


Abdominal  aorta 
Common  iliac  artery 
Middle  sacral  artery 
Internal  iliac  artery 
External  iliac  artery 
Obturator  artery 
Sciatic  artery 
Pudic  artery 

Internal  circumflex  artery 
'  Superficial  femoral  artery 


'  Perforating  branches  ofprofunda 


Popliteal  artery 


Superior  external  articular 


Inferior  external  articular 
External  lateral  ligament  — 
Tibial  recurrent 


Anterior  libial  artery 


Peroneal  artery  . 


External  malleolar  branch 
Anterior  peroneal  artery 
Posterior  peroneal  artery 

External  plantar  artery 


Anas/omotica  magna 

Terminal  branch  ofprofunda  anastomosing 
with  popliteal 


Superior  internal  articular 


Internal  lateral  ligament 
Inferior  internal  articular 
Posterior  tibial  artery 


.  Internal  malleolar  branch 


Tarsal  branch 
.  Dorsalis  pedis  artery 
.  Metalarsal  branch 


ARTICULATIONS 


239 


DEMONSTRATION    XVI. 

ARTICULATIONS  AND  LIGAMENTS. 

Classes  of  articulations. 
Various  movements  of  joints. 
Articulation  of  the  pelvis. 

Pelvis  with  the  spine. 

Sacro-iliac. 

Sacro-coccygeal. 

Symphysis  of  pelvis. 


FIG.  286. — ANTERIOR  VIEW  OF  THE  LIGAMENTS  BETWEEN  THE  SPINE  AND  PELVIS. 

(Morris.) 


Foramen  for  last 

lumbar  nerve 
Intervertebral  body 
between  last  lum- 
bar and  first  sacral 
vertebrae 


Foramen  for  anterior  primary  branch  of  fourth 
lumbar  nerve 


The  ilio-lumbar 
ligament 


The  sacro-lumbar 
ligament 


Superior  sacro-iliac 
ligament 


Anterior  sacro-iliac 
ligament 


Great  sacro-sciatie 
ligament 


Leaser  sacro-sciatic 
ligament 


240 


ARTICULATIONS 


FIG.   287. — VERTICAL  ANTERO-POSTERIOR  SECTION  OF  THE  PELVIS. — (Morris.) 


Superior  aacro-iliac 
ligament 


Anterior  sacro-iliac 

ligament 

Inferior  aacro-iliac 
ligament 


Small  sacro-sciatic 
ligament 


Great  sacro-seiatic 
ligament 


FIG.   288. — SACRO-SCIATIC  LIGAMENTS.     (Posterior  view.)     (Morris.) 


Posterior  or  great  sacro- 
sciatio  ligament 


Anterior  or  small  sacro- 
sciatic  ligament 


brm  process  of  the 
;reat  ligament 


nuscle,  continuous  with 
o-sciatic  ligament 


ARTICULATIONS 


241 


FIG.   289. — ANTERIOR  VIEW  OF  THE  SYMPHYSIS  PUBIS  (MALE),  SHOWING  THE  DECUSSA- 
TIOX  OF  THE  FIBRES  OF  THE  ANTERIOR  LIGAMENT. — (Morris.) 


Superior  pubic  ligament 


Inferior  pubic  ligament 


Hip-joint.     Ligaments  are: — 

Capsular.  Teres. 

Ilio-femoral.  Cotyloid. 

Transverse. 


FIG.   290. — ANTERIOR  VIEW  OF  THE  CAPSULE  OF  THE  HIP-JOINT. — (Morris.') 


Tendon  of  rectus  pulled  up 


Tendino-trochanteric  band  passing 
between  reetus  and  vastus  externuj 

Placed  on  the  weak  spot  of  capsule, 
which  is  sometimes  perforated  to 
allow  the  bursa  under  psoaa  to  com- 
municate with  joint 

nio-femoral  band 

Pectineo-femoral  band 


242 


ARTICULATIONS 


FIG.  291. — HIP-JOINT   AFTER   DIVIDING   THE   CAPSULAR   LIGAMENT    AND    DISARTICULATING 

THE  FEMUR. — (Morris.} 


Ligamentuin  teres 


Capsular  ligament 


aular  ligament,  cut 

id  ligament 


r  ligament 


FIG.   292. — PORTIONS  OF  ISCHIUM  AND  PUBES,  SHOWING  THE  COTYLOID  NOTCH  AND  THE 
LIGAMENTUM  TERES  ATTACHED  OUTSIDE  THE  ACETABULUM. — (Morris.) 


Transverse  ligament 


Cotyloid  ligament 


Transverse  ligament 


Ligamentum  teres  attached 
to  ischium  outside  the 
acetabulum 


ARTICULATIONS 


243 


FIG.   293. — SECTION*  THROUGH  THE  HIP-JOINT,  SHOWING  THE  COTYLOID  LIGAMENT,  LIGA- 
MENTUM  TERES.   AND  RETINACULA. — (^Morris.) 


Ligamentum  terea. 
The  upper  line  is 
placed  on  the  fem- 
oral, the  lower  on 
the  ischial  attach- 
ment 


Cotyloid  cartilage 

— —  Capsular  ligament 
Keflected  fibres  of 
capsule      (retin- 
aculai 


—  Keflected  fibres  of 
capsule 


244 


ARTICULATIONS 


Knee-joint. 

External  ligaments. 

Anterior,  or  ligament um  patellae. 

Posterior. 

Internal  lateral. 

Two  external  lateral. 

Capsular. 
Interior  ligaments. 

Anterior  or  external  crucial. 

Posterior  or  internal  crucial. 

Two  semilunar  fibre-cartilages. 

Transverse. 

Coronary. 

Ligamentum  mucosum.     Processes  of  synovial 

Ligament  alaria.  membrane. 


FIG.  294. — POSTERIOR  VIEW  OF  THE  KNEE-JOINT. — (Morris.') 


Outer  head  of  gaatrocnemius 


External  lateral  ligament: 
anterior  portion 


Posterior  part  of  external 
lateral  ligament 
Tendon  of  popliteus 

Tendon  of  biceps Q* 

Posterior  superior  tibio- 
fibular  ligament 


Tendon  of  adductor  magnua 


Inner  head  of 
gastrocuemiiu 


Tendon  of  •emi-membra- 
nosus  with  its  slip  to 
thicken  the  posterior  liea- 
ment 


—  Internal  lateral  ligament 


ARTICULATIONS 


245 


FIG.   295. — ANTERIOR  VIEW  OF  THE  INTERNAL  LIGAMENTS  OF  THE  KNEE-JOINT. — (Morris.) 


Aperture  leading  into  the 
bursa  beneath  the  quadri- 
ceps extensor 


Attachment  of  capsular,  or 
anterior  ligament  to  femur 


Fatty  tissue  within  cut  edge 
of  ligamentum  mucosum 


Anterior  crucial  ligament 


External  semilunar 

flbro-cartilage 


Coronary  ligament 


Posterior  crucial  ligament 


Internal  semilunar 
fibro-cartilage 


—  Transverse  ligament 
Coronary  ligament 


246 


ARTICULATIONS 


FIG.   296. — STRUCTURES  LYING  ON  THE  HEAD  OF  THE  TIBIA.      (Right  knee.)     (Morris.} 

Ligamentum  patellae  - 


Transverse  ligament 


Anterior  crucial 


Internal  semilunar  flbro- 
cartilage 


Posterior  crucial 
ligament 


Expansion  from  quadriceps 
extensor  tendon. 


External  semilunar  flbro- 
cartilage 


•Tendon  of  biceps 
External  lateral  ligament 


FIG.   297. — ANTERIOR  VIEW  OF  THE  KNEE-JOINT,'  SHOWING  THE  SYNOVIAL  LIGAMENTS. 

(Morris.} 
(Anterior  portion  of  capsule  with  the  extensor  tendon  thrown  downwards.) 


Posterior  crucial 


Ligamentum  mucosum 


Alar  ligament 


Synovial  pouch  under  tendon 
of  quadriceps  extensor 


Alar  ligament 


ARTICULATIONS 


247 


FIG  208  —VERTICAL  SECTION  OF  THE  KNEE-JOINT  IN  THE  ANTERO-POSTERIOR  DIRECTION.— 

(Morris.} 
(The  bones  are  somewhat  drawn  apart.) 


Fatty  tissue 
Opening  in  synovial 
membrane    behind 
crucial       ligament 
leading  into  inner 
half  of  joint 
Synovial  membrane  re- 
flected off  crucial  liga- 
ments 
Cut  end  of  anterior  cru  - 

cial  ligament 
Posterior  crucial  liga  - 

ment 
Ligament  of  Winslow 


Muscular  fibres  of  quadriceps 
extensor 


Extension  of  synovial  sac  of  knee 
upon  femur 


Tendon   of  quadriceps   extensor, 
forming  fibrous  capsule  of  joint 


PATELLA 
Pre-patellar  bursa 

CONDYLEOF  FEMUR  (INNER) 
Ligamentum  mucosum 


Patty  tissue  bet-ween 
ligamentum  patellae 
and  synovial  sac 


Bursa  beneath  ligamentum 
patellae 


ISA 


248 


ARTICULATIONS 

FIG.   299. — CRUCIAL  LIGAMENTS  IN  FLEXION. — (Morris.} 


Posterior  crucial 


Anterior  crucial 

Internal  semilunar 

cartilage 
Transverse  ligament 


Slip  from  external  cartilage  to  femur 
External  aemilunar  cartilage 


Coronary  ligament 

Antero-superior  tibio-flbular  ligament 


Tibio-fibular  union.     Ligaments  are:— 
Superior  tibio-fibular  joint. 

Capsular. 

Anterior  tibio-fibular. 

Posterior  tibio-fibular. 
Middle  tibio-fibular  union. 

Interosseous  membrane. 
Inferior  tibio-fibular. 

Anterior  inferior  tibio-fibular. 

Posterior  inferior  tibio-fibular. 

Transverse. 

Inferior  interosseous. 

Ankle-joint.     Ligaments  are:— 
Anterior. 
Posterior. 
Internal  lateral. 
External  lateral. 


COMPLIMENTS 
OF 


iston's  SOB  Co., 


ARTICULATIONS 


249 


FIG.  300. — RIGHT  ANKLE-JOINT,  SHOWING  THE  LIGAMENTS. — (Morris.} 
(From  dissection  by  Mr.  W.  Pearson,  of  the  Royal  College  of  Surgeons'  Museum.) 


Superficial  fibres  of  anterior  / 
inferior  tibio-nbular  liga-  j 
ment 

Deep  fibres  of  anterior  inferior 
tibio-nbular  ligament 


^  of  ex- 
Anterior  fasciculus  I  ter 
Posterior  fasciculus  flat 
Middle  fasciculus     j 

ment 


if  ex-  , 
ernal  { 
ateral \ 

"«£-.    I 


Internal  lateral  ligament 


FIG.   301. — INNER  VIEW  OF  THE  ANKLE  AND  THE  TARSUS,  SHOWING  THE  GROOVE  FOR  THE 
TENDON  OF  THE  TIBIALIS  POSTICUS. — (Morris.) 


Internal  lateral 
ligament 


Inferior  cal- 

caneo-seaphoid 

ligament 


long  plantar  ligament 


250  ARTICULATIONS 

FIG.   302. — LIGAMENTS  SEEN  FROM  THE  BACK  OF  THE  ANKLE-JOINT. — (Morris.) 


Posterior  ligament  of  ankle- 
joint 


Posterior  part  of  the  internal 
lateral  ligament 


The  lower  part  of  the  inter- 
osseous  membrane 


Transverse  lieament  of  inferior 
tibio-abular  joint 


Posterior  fasciculus  of  external 
lateral  ligament 


Middle  fasciculus  of  external 
lateral  ligament 


FIG.  303. — EXTERNAL  VIEW  OF  THE  LIGAMENTS  OF  THE  FOOT  AND  ANKLE. — (Morris.) 


Antero-inferior  tibio-flbular 
ligament 


Outer  extremity  of  the 
iuterosseous  ligament 


External  calcaneo- 
scaphoid  ligament 


Postero-inferior  tibio- 
flbular  ligament 


Fasciculus  of  posterior 
ligament  of  ankle 


Posterior  fasciculus  ol 
external  lateral  ligament 


Internal  calcaneo-cuboid        Dorsal     External    Middle  fasciculus  of  external  lateral 
calcaneo-    calcaneo-  ligament  of  the  ankle 

cuboid        astragaloid 
ligament 


ARTICULATIONS  251 

Tarsal  joints  are:— 

Calcaneo-astragaloid. 

Anterior  portion  of  tarsus. 

Medio-tarsal. 

Expose  and  study  the  ligaments  of  the  above  joints. 
Clean  and  study  the  ligaments  of  the  following  joints  :— 
Tarso-metatarsal. 
Intermetatarsal. 
Metatarso-phalangeal. 
Interphalangeal. 
Study  the  blood-  and  nerve-supply  of  each  joint. 

FIG.  304. — VIEW  OF  THE  FOOT  FROM  ABOVE,  WITH  THE  ASTRAGALUS  REMOVED  TO  SHOW 
THE   INFERIOR  AND  EXTERNAL  CALCANEO-SCAPHOID  LIGAMENTS. — (Morris.) 


Dorsal  cu  bo-scaphoid 

ligament 

Dorsal  oalcaneo-cuboid 

ligament 

Internal  calcaneo-cuboid 

ligament 

External  calcaneo-scaphoid 

ligament 


Cut  edge  of  interosseous 
ligament 


Inferior  calcaneo-seaphoid 
ligament 

Tendon  of  tibialia  poaticus 


252 


ARTICULATIONS 


FIG.  305. — LIGAMENTS  OF  THE  SOLE  OF  THE  LEFT  FOOT. — (Morris.) 


Long  plantar  or  long  inferior 
caleaneo-cuboid  ligament 


Tendon  of  peroneus  longus 


GROOVE  FOR  FLEXOR  LONGUS 
HALLUCIS 

Inferior  calcaneo-seaphoid 

ligament 

Short  plantar  or  short  inferior 
calcaneo-cuboid  ligament 


TUBERCLE  OF  SCAPHOID 


INTERNAL  CUNEIFORM 


Insertion  of  peroneus 

longus 


FIG.  306. — SECTION  TO  SHOW  THE  SYNOVIAL  CAVITIES  OF  THE  FOOT. — (Morris.) 


1.  Posterior  calcaneo-astragaloid.  2.  Calcaneo-cuboid. 

4.  Tarsal.  5.  Cubo-metatarsal. 


3.  Anterior  calcaneo-astrapalo-scaphoid. 
6.  J'irst  metatarso-cuueiforiu. 


SECTIOX  OF  HIP-JOINT 


253 


The  examinations  of  the  following  figures  will  help  to  understand  and 
remember  the  relative  positions  of  the  structures  exposed  by  the  sections. 

FIG.  307. — TRANSVERSE   SECTION   OF  THE   HIP-JOINT   AND   ITS   RELATIONS.     (One-third.) 

(Braune.)     (Morris.) 


ANTERIOR  CRURAL 

jy    >r/>-- 

OF   ILIA- 
UfTERNUa 

External  iliac  artery 


Obturator  internus 


Adductor  magnus  * — 


i 

tor  externua * 


Obtura 


Adductor  longus 
Adductor  brevls 


^ Gluteus  minimus 

Glutens  mediua 


Pectineus 
—  Ilio-psoas 


FIG.  308. — SECTION  THROUGH  THE  HIP  AND  GLUTEAL  REGION.     (One-third.)       (Morris.) 


Sartoriua 

Reflected  tendon 

rectus 
Psoea  and  iliacus 

and  buraa         v 
AXTERInr. 
CR L'RAL  SER VE^~ 
Common  femoral  -^. 

artery 
Cvmmon  femoral  vein  ^^ 

Pnfunda  resself 

Gracilis  'gSJSff- ' 
Semi-membranoaoa  -jffi-jffi- 

Adductor  brevis  - 

'  -  •'  -    ; 

Semi-tendinosus  •--. 
Obturator  externus 


Adductor  longus 
Adductor  magnus 


Gluteus  maiimus 
Gluteus  mediua 


-  Gluteus  minimus 


Pyriformis 
GREA  T  $CIA  TIC 

XER  VE  and  sciatic. 

vessels 

Obturator  internus 
Gemelli  , 

Biceps 
Quadratus  femoris 


254 


SECTION  OF  THIGH 


FIG.  309.  —  SECTION  OF  THE  RIGHT  THIGH  AT  THE  APEX  OF  SCARPA'S  TRIANGLE. 

(Morris.} 


(Heath.) 


Femoral  vessels 


Sartorius 
EXTERNAL  CUTANEOUS  NERVE 


KectuB  femoris 
ANTERIOR  CRURAL 

NER  VE 
External  circumflex 

vessels 
Tensor  fasciae  femoris 

Vastua  internus  and 
crureus 


Vastus  externus 


Pro/undo,  ressels 

Adductor  longus 

SUPERFICIAL  PART  OF  OBTURATOR 
NERVE 


Biceps  femoris 


Gracilis 
Pectineus 
Adductor  brevjs 
Itl-.EP  PART  OF  OB- 
TURATOR NERVE 
Adductor  magnus 

Semi-membrauoauB 


Semi-tendinosua 

SMALL  SCI  A  TIC  NER  VE 
GREA  T  SCIA  TIC  NER  VE 


FIG.  310. — SECTION  OF  THIGH  THROUGH  UPPER  PART  OF  HUNTER'S  CANAL.     (W.  A.) 

(Morris, ) 


Lymph  spaces 


LONG  SAPHE- 
NOUS  NERVE 

Femoral  artery,  with 
tmall  vena  comitet 
( femoral  vein  deeper) 

Sheath  of  vessels 


Long  saphenous  vein 


Lymph  spaces 
Superficial  fascia 


Deep  fascia  contin- 
ued over  back  of 
thigh  as  superfi- 
cial layer  of  deep 
fascia 


Middle  layer  of 
deep  fascia 


Deep  layer  of  deep 
fascia  (muscular 
aponeurosis) 


GREA  T  SCIA  TIC  NER  VE      Vein 


SECTION  KNEE-JOINT  AND  LEG 


255 


FIG.  311. — HORIZONTAL  SECTION  OF  THE  KNEE-JOINT.     (One-half.)     (Morris.) 


PATELLA 


Synovial  membrane 


Crucial  ligaments  — 

Bicepp 

Outer  head  of  gaatroenemius 
J'rj/ilHeal  artery 

EXTERNAL  POPLITEAL  SERVE 

Poplilfiil   rein 
IXTERXAL  POPLITEAL  NERVE 

External  savhena  rein 


—  Inner  head  of  gastrocremius 

' Sartorius 

. Graeilis 

Semi  -mem  branosus 
Semi-tendinosua 


FIG.  312. — SECTION  OF  .THE  RIGHT  LEG  IN  THE  UPPER  THIRD.     (Heath.)     (Morris.) 


Tibialis  anti 

Extensor  longus  digitoru 
Anterior  libial  vessels  and  SER\'E 
Peroneua longua 


Flexor  longus  halluci 
Soleus  with  fibrous  intersectio: 

Gastroenemiu: 


Tibialis  posticus 
Flexor  longua  digitorum 

Internal  saphenous  rein 


COMMCSICAXS  PEROXEI  XER  VE       '       I 

Peroneal  vessel*]      Posterior  libiul  rtssels  and  SERVE 
External  saphenous  vein  and  SER  \  'E 


256 


SECTION  OF  FOOT 


FIG.  313. — VERTICAL  SECTION  THROUGH  THE  CUNEIFORM  AND  CUBOID  BONES.     (One-half.) 

(Morris.} 


Dorsalis  pedis  vessels  and  NER  VE 
Extensor  proprius  hallucis 

INTERNAL  CUNEIFORM  MIDDLE  CUNEIFORM 


Tibialia  antieu 


EXTERNAL  CUNEIFORM 

Extensor  brevis  digitorum 
Dorsal  apoueurosis 
CUBOID 

Peroneus  tertius 


Abductor  hallucis 
Internal  plantar  vessels  and  NER  VE 


Abductor  hallucis 
Flexor  longus  hallucis 

Plantar  fascia 
Flexor  longus  digitorum 

Flexor  brevis  digitorum 


Abductor  minimi  digit! 


External  plantar  vessels  and  NERVE 
Tendon  of  peroneus  lougus 


FIG.  314. — LONGITUDINAL    SECTION    OF    FOOT.      (One-third.)      (Braune.)      (Morris.) 


Tendo  Achillis 
Posterior  tibial  vessels 
ASTRAGALUS  and  NERVE 


SCAPHOID 
INTERNAL  CUNEIFORM 


Extensor  proprius 


Flexor  longus  hallueis 
Flexor  brevis  hallucis 

Lumbricalis 


CALCANEUM 

Abductor  minimi  diglti 
External  plantar  vessels  and  NERVE 


Accessoriua 


Flexor  brevis  digitorum      Flexor  communis  digitorum 
INTERNAL  PLANTAR  NERVE 


1 


I  ( 


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DEC  2  0  I94fi 


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Y95 
1906 


Yubzy 


,  S.M. 
manual  and 
dissection. 


Library  ol  the 
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